Provider Demographics
NPI:1053361196
Name:WATSON, CHRISTINE KIRKENDOL (MD)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:KIRKENDOL
Last Name:WATSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:M
Other - Last Name:KIRKENDOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7250 CLEARVISTA DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-4640
Practice Address - Country:US
Practice Address - Phone:317-621-5673
Practice Address - Fax:317-621-6040
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01055140A207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000752103OtherANTHEM
IN200414940FMedicaid
IN000000752103OtherANTHEM
INH79669Medicare UPIN
IN165460BBBBMedicare ID - Type Unspecified