Healthcare Provider Details

I. General information

NPI: 1033564018
Provider Name (Legal Business Name): CHRISTIAN FERNANDEZ OLORTEGUI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: CHRISTIAN FERNANDEZ M.D.

II. Dates (important events)

Enumeration Date: 04/27/2016
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 W HARRISON ST
CHICAGO IL
60612-3714
US

IV. Provider business mailing address

1901 W HARRISON ST
CHICAGO IL
60612-3714
US

V. Phone/Fax

Practice location:
  • Phone: 312-864-3838
  • Fax:
Mailing address:
  • Phone: 312-864-3838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number036.156089
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: