Healthcare Provider Details

I. General information

NPI: 1992819916
Provider Name (Legal Business Name): CHRISTOPHER JOHN JAPOUR D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 10/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 W LOCKPORT RD
PLAINFIELD IL
60544-1832
US

IV. Provider business mailing address

PO BOX 1482
PLAINFIELD IL
60544
US

V. Phone/Fax

Practice location:
  • Phone: 815-254-3338
  • Fax: 815-436-8367
Mailing address:
  • Phone: 630-439-4343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016-004837
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier016-004837
Identifier TypeMEDICAID
Identifier StateIL
Identifier Issuer
# 2
IdentifierPENDING
Identifier TypeMEDICAID
Identifier StateIL
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: