Healthcare Provider Details

I. General information

NPI: 1609403435
Provider Name (Legal Business Name): CHRISTOPHER J FELICELLI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E HURON ST STE 7-132N
CHICAGO IL
60611-3055
US

IV. Provider business mailing address

251 E HURON ST STE 7-132N
CHICAGO IL
60611-3055
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-3211
  • Fax: 312-926-3127
Mailing address:
  • Phone: 312-926-3211
  • Fax: 312-926-3127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number125.075533
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number036167263
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: