Healthcare Provider Details

I. General information

NPI: 1881649697
Provider Name (Legal Business Name): GEORGE WILLIAM CHRISTY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22285 N PEPPER RD
LAKE BARRINGTON IL
60010-2538
US

IV. Provider business mailing address

22285 N PEPPER RD STE 103
LAKE BARRINGTON IL
60010-2539
US

V. Phone/Fax

Practice location:
  • Phone: 224-357-8133
  • Fax: 224-357-8048
Mailing address:
  • Phone: 224-357-8133
  • Fax: 847-717-7313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036105490
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036105490
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number036105490
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: