Basic Information
| Provider Information | |||||||||
| NPI: | 1518921444 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THORESEN | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4685 FOREST AVE | ||||||||
| Address2: | STE C | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452123359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5133664488 | ||||||||
| FaxNumber: | 5133664480 | ||||||||
| Practice Location | |||||||||
| Address1: | 10506 MONTGOMERY RD | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452424487 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137927800 | ||||||||
| FaxNumber: | 5137927807 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2006 | ||||||||
| LastUpdateDate: | 09/29/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 35058470 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 2520404 | 01 | UNITED | OTHER | 39948894005 | 01 | MEDICAL MUTUAL OF OHIO | OTHER | 283926 | 01 | AMERIGROUP | OTHER | 100350220 | 05 | IN | MEDICAID | 000000019929 | 01 | ANTHEM | OTHER | 0875003 | 05 | OH | MEDICAID | 11438871058 | 01 | CARESOURCE | OTHER | 58470-13 | 01 | HUMANA | OTHER | 0645403 | 01 | AETNA | OTHER | 64869753 | 05 | KY | MEDICAID | P00023081 | 01 | OH | RAILROAD MEDICARE | OTHER |