Healthcare Provider Details

I. General information

NPI: 1396249967
Provider Name (Legal Business Name): CRISTINA ELENA MARTI AMARISTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRISTINA MARTI-AMARISTA MD

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 W 95TH ST
OAK LAWN IL
60453-2735
US

IV. Provider business mailing address

6101 W 95TH ST
OAK LAWN IL
60453-2735
US

V. Phone/Fax

Practice location:
  • Phone: 708-261-0831
  • Fax: 773-790-4077
Mailing address:
  • Phone: 708-261-0831
  • Fax: 773-790-4077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036165663
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: