Individual
CHRISTOPHER J. GULLETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7910 W JEFFERSON BLVD STE 102, FORT WAYNE, IN 46804-4159
(260) 458-3555
(260) 458-3530
Mailing address
6920 POINTE INVERNESS WAY STE 200, FORT WAYNE, IN 46804-7934
(260) 479-3514
(260) 479-3520
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
01084289A
IN
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
059743
GA
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
M9331
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
194291401
—
TX
05
—
204267127A
—
GA
01
—
8AA851
BLUE CROSS
TX
Enumeration date
07/20/2007
Last updated
09/30/2020
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