Provider Demographics
NPI:1235387713
Name:ANZEVENO, CHRISTOPHER JON (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JON
Last Name:ANZEVENO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:17840 BAGLEY RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3401
Mailing Address - Country:US
Mailing Address - Phone:440-531-6000
Mailing Address - Fax:440-531-6195
Practice Address - Street 1:17840 BAGLEY RD
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3401
Practice Address - Country:US
Practice Address - Phone:440-531-6000
Practice Address - Fax:440-531-6195
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11013341A207R00000X
MN66561207R00000X
OH35.149888207RB0002X
IN01069170A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine