Individual
CHRISTOPHER P VONHAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2601 W MAIN ST, CARBONDALE, IL 62901-1031
(618) 549-5361
(618) 351-4878
Mailing address
2601 W MAIN ST, CARBONDALE, IL 62901-1031
(618) 549-5361
(618) 351-4878
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
02004335A
IN
207Y00000X
Otolaryngology Physician
Primary
036073211
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02004335B
—
IN
05
—
036073211
—
IL
01
—
214881
MEDICARE GROUP PTAN
IL
Enumeration date
09/30/2005
Last updated
02/01/2017
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