MEDICARE: CHRISTOPHER STALLTER D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	036-089685	IL

General Provider Information

NPI Number	:	1134115629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER STALLTER D.O.

Provider Business Mailing Address
First Line	:	2972 INDIAN TRAIL RD STE A
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60502-9408
Country	:	US
Telephone Number	:	630-499-0812
Fax Number	:	630-499-0823

Provider Business Practice Location Address
First Line	:	2972 INDIAN TRAIL RD
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60502-9408
Country	:	US
Telephone Number	:	630-499-0812
Fax Number	:	630-499-0823

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	07/21/2020

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