Healthcare Provider Details

I. General information

NPI: 1033841374
Provider Name (Legal Business Name): CHRISTOPHER JAMES MAGULICK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 N COURT ST
GRAYVILLE IL
62844-1002
US

IV. Provider business mailing address

2450 S TELSHOR BLVD
LAS CRUCES NM
88011-5076
US

V. Phone/Fax

Practice location:
  • Phone: 618-375-7101
  • Fax: 618-375-7183
Mailing address:
  • Phone: 575-521-5385
  • Fax: 575-521-5568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036.174584
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: