Provider Demographics
NPI:1447215371
Name:WATKINS, CHRISTOPHER SHANE (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:SHANE
Last Name:WATKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-559-9529
Mailing Address - Fax:502-272-5339
Practice Address - Street 1:200 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1831
Practice Address - Country:US
Practice Address - Phone:502-629-8000
Practice Address - Fax:303-306-7753
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2025-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32170207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
5145390OtherCIGNA / CMA DBA
KY64321706Medicaid
000000350754OtherANTHEM / CMA DBA
019327OtherSIHO / CMA DBA
2440458000OtherPASSPORT ADVANTAGE / CMA DBA
1169467OtherPASSPORT / CMA DBA
000052152DOtherHUMANA / CMA DBA
KYP00332737OtherRAILROAD MEDICARE
IN200426460Medicaid
IN200426460Medicaid
KY0361971Medicare PIN