Healthcare Provider Details

I. General information

NPI: 1285312017
Provider Name (Legal Business Name): CHRISTINA LUCIA ROSA CARFAGNINI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 NE GLEN OAK AVE
PEORIA IL
61637-0001
US

IV. Provider business mailing address

5250 N KNOXVILLE AVE APT 220
PEORIA IL
61614-5028
US

V. Phone/Fax

Practice location:
  • Phone: 309-624-9351
  • Fax:
Mailing address:
  • Phone: 309-992-1445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125082565
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: