Basic Information
Provider Information
NPI: 1639104615
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CADMAN
FirstName: CHRISTOPHER
MiddleName: S
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2300 N EDWARD ST
Address2: GSBLL
City: DECATUR
State: IL
PostalCode: 625264163
CountryCode: US
TelephoneNumber: 2178762857
FaxNumber: 2178762874
Practice Location
Address1: 2300 N EDWARD ST
Address2: SUITE 2400
City: DECATUR
State: IL
PostalCode: 625264163
CountryCode: US
TelephoneNumber: 2178762400
FaxNumber: 2178762405
Other Information
ProviderEnumerationDate: 07/11/2006
LastUpdateDate: 09/12/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0000XM10397IDY Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease

No ID Information.


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