Provider Demographics
NPI:1730270935
Name:MONNIKENDAM, CHRISTOPHER SIMON (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:SIMON
Last Name:MONNIKENDAM
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 1:817 SATINWOOD CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-5882
Mailing Address - Country:US
Mailing Address - Phone:501-213-7303
Mailing Address - Fax:
Practice Address - Street 1:400 CELEBRATION PL
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34747-4970
Practice Address - Country:US
Practice Address - Phone:407-303-2528
Practice Address - Fax:407-303-2760
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4752732080N0001X
VA01012660172080N0001X
FLME1598452080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR06070017800OtherQUALCHOICE
ARP00406126OtherRAILROAD MEDICARE
AR163014001Medicaid
ARP00406126OtherRAILROAD MEDICARE
AR163014001Medicaid