Healthcare Provider Details

I. General information

NPI: 1255444915
Provider Name (Legal Business Name): CHRISTOPHER MARKUS COLBERT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 01/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20201 CRAWFORD AVE
OLYMPIA FIELDS IL
60461-1010
US

IV. Provider business mailing address

500 E 51ST ST PROVIDENT HOSPITAL
CHICAGO IL
60615-2400
US

V. Phone/Fax

Practice location:
  • Phone: 708-744-4000
  • Fax:
Mailing address:
  • Phone: 312-572-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036115771
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: