Healthcare Provider Details

I. General information

NPI: 1356342331
Provider Name (Legal Business Name): CHRISTA S PESTKA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14410 ROUTE 37
JOHNSTON CITY IL
62951-1427
US

IV. Provider business mailing address

PO BOX 155
CHRISTOPHER IL
62822-0155
US

V. Phone/Fax

Practice location:
  • Phone: 618-983-6911
  • Fax: 618-983-6913
Mailing address:
  • Phone: 618-724-2401
  • Fax: 618-724-4628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-107039
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: