Healthcare Provider Details

I. General information

NPI: 1760778880
Provider Name (Legal Business Name): CHRISTOPHER JARED SCIAMANNA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2011
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 W 95TH ST FL STREET6
OAK LAWN IL
60453-2600
US

IV. Provider business mailing address

4400 W 95TH ST STE 308
OAK LAWN IL
60453-2660
US

V. Phone/Fax

Practice location:
  • Phone: 708-684-4884
  • Fax:
Mailing address:
  • Phone: 708-346-4040
  • Fax: 708-346-3287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number036145716
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number036-145716
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036145716
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036145716
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: