Healthcare Provider Details

I. General information

NPI: 1265514962
Provider Name (Legal Business Name): CHRISTINE AMSTADT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 02/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 RAYMOND DR STE 200
NAPERVILLE IL
60563
US

IV. Provider business mailing address

636 RAYMOND DR STE 200
NAPERIVLLE IL
60563
US

V. Phone/Fax

Practice location:
  • Phone: 630-355-5302
  • Fax: 630-778-6088
Mailing address:
  • Phone: 630-355-5302
  • Fax: 630-778-6088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036-093359
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-093359
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: