Individual
CHRISTOPHER ROBERT VITALE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
5050 N CLINTON ST, FORT WAYNE, IN 46825-5886
(260) 484-8551
(260) 482-5060
Mailing address
5052 N CLINTON ST, FORT WAYNE, IN 46825-5822
(260) 484-8551
(260) 482-5060
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
02004802A
IN
207X00000X
Orthopaedic Surgery Physician
20A14021
CA
207X00000X
Orthopaedic Surgery Physician
5101018805
MI
207XX0801X
Orthopaedic Trauma Physician
02004802A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12488756
CAQH
—
05
—
201368500
—
IN
Enumeration date
06/30/2010
Last updated
10/23/2018
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