Christian Jon Wunderlich, D.P.M.

Primary specialty

PodiatristTaxonomy code 213E00000X

License

000476 Issued in MO

Practice address

118 E Jefferson Ave
Suite 200
Kirkwood, MO 63122-4026

Phone

(314) 821-6585

Fax

(314) 821-6594

NPI assigned

May 30, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1278979200000",
    "number": "1528015070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 E JEFFERSON AVE",
            "address_2": "SUITE 200",
            "city": "KIRKWOOD",
            "state": "MO",
            "postal_code": "631224026",
            "telephone_number": "314-821-6585",
            "fax_number": "314-821-6594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 E JEFFERSON AVE",
            "address_2": "SUITE 200",
            "city": "KIRKWOOD",
            "state": "MO",
            "postal_code": "631224026",
            "telephone_number": "314-821-6585",
            "fax_number": "314-821-6594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WUNDERLICH",
        "first_name": "CHRISTIAN",
        "middle_name": "JON",
        "name_prefix": "Dr.",
        "credential": "D.P.M.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-30",
        "last_updated": "2010-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "MO",
            "license": "000476",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "301865002",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Podiatrist in Kirkwood, MO
• Providers in Kirkwood, MO by specialty
• Podiatrist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.