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Individual

CHRISTOPHER JAMES CLEVELAND

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
14645 HAZEL DELL RD, NOBLESVILLE, IN 46062-7066
(317) 922-2090
(317) 574-1875
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10002113A
IN
363A00000X
Physician Assistant

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
264430712
MEDICARE PTAN
IN
05
300012708
IN
01
IN2614066
MEDICARE PTAN
IN
Enumeration date
07/21/2016
Last updated
06/29/2023
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