Healthcare Provider Details

I. General information

NPI: 1225027220
Provider Name (Legal Business Name): CHRISTOPHER B MCCARTHY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 NE GLEN OAK AVE
PEORIA IL
61636-1000
US

IV. Provider business mailing address

221 NE GLEN OAK AVE
PEORIA IL
61636-1000
US

V. Phone/Fax

Practice location:
  • Phone: 309-672-5654
  • Fax: 309-672-5735
Mailing address:
  • Phone: 309-672-5654
  • Fax: 309-672-5735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number036090449
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036090449
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036090449
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: