MEDICARE: DR. JIM A. CHRISTOFORIDIS M.D.

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	036103428	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578546222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JIM A. CHRISTOFORIDIS M.D.

Provider Business Mailing Address
First Line	:	1431 N WESTERN AVE
Second Line	:	SUITE # 406
City	:	CHICAGO
State	:	IL
Zip	:	60622-1797
Country	:	US
Telephone Number	:	312-633-5841
Fax Number	:	312-491-5485

Provider Business Practice Location Address
First Line	:	4235 W NORTH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-4852
Country	:	US
Telephone Number	:	773-278-6868
Fax Number	:	773-278-6922

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

Provider Enumeration Date	:	11/28/2005
Last Update Date	:	06/03/2009

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