Provider Demographics
NPI:1447517958
Name:BELLM, CHRISTOPHER PATRICK (PA)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:PATRICK
Last Name:BELLM
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7025 THICKETT DR APT 1D
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-2613
Mailing Address - Country:US
Mailing Address - Phone:573-544-5494
Mailing Address - Fax:
Practice Address - Street 1:3000 WOODCREEK DR STE 200B
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-9600
Practice Address - Country:US
Practice Address - Phone:573-544-5494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10001399A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant