Basic Information
| Provider Information | |||||||||
| NPI: | 1306138441 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAWK | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5401 S CONGRESS AVE STE 102 | ||||||||
| Address2: | |||||||||
| City: | ATLANTIS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334626636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5619675033 | ||||||||
| FaxNumber: | 5619678974 | ||||||||
| Practice Location | |||||||||
| Address1: | 5401 S CONGRESS AVE STE 102 | ||||||||
| Address2: | |||||||||
| City: | ATLANTIS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334626636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5619675033 | ||||||||
| FaxNumber: | 5619678974 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2011 | ||||||||
| LastUpdateDate: | 10/04/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0011X | ME122703 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.