Individual
MRS. CHRISTINE MARIE MADDOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
F.N.P.
Contact information
Practice address
8865 W 400 N STE 120, MICHIGAN CITY, IN 46360-9011
(219) 878-5031
(219) 879-5498
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71001740A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001078424
ANTHEM BCBS
IN
05
—
201007040
—
IN
01
—
M400035552
MEDICARE PTAN
IN
Enumeration date
01/31/2006
Last updated
10/11/2023
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