Healthcare Provider Details

I. General information

NPI: 1336181189
Provider Name (Legal Business Name): CHRISTOPHER D LANSFORD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 01/06/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2502 E EMPIRE ST STE A
BLOOMINGTON IL
61704-3739
US

IV. Provider business mailing address

101 W UNIVERSITY AVE
CHAMPAIGN IL
61820-3909
US

V. Phone/Fax

Practice location:
  • Phone: 309-589-5900
  • Fax:
Mailing address:
  • Phone: 309-589-5900
  • Fax: 309-689-0312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number036116055
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: