Provider Demographics
NPI:1982889770
Name:CHRISTOPHER H. FARIS, DPM
Entity Type:Organization
Organization Name:CHRISTOPHER H. FARIS, DPM
Other - Org Name:NILES FAMILY PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:H
Authorized Official - Last Name:FARIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:269-684-0166
Mailing Address - Street 1:719 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-2637
Mailing Address - Country:US
Mailing Address - Phone:269-684-0166
Mailing Address - Fax:269-684-8034
Practice Address - Street 1:719 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-2637
Practice Address - Country:US
Practice Address - Phone:269-684-0166
Practice Address - Fax:269-684-8034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI590100116200213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1948394Medicaid
MI4599300001Medicare NSC
5115047Medicare PIN
U23046Medicare UPIN