MEDICARE: DR. CHRISTOPHER JOHN RIVERA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	036096480	IL
2	207R00000X	Internal Medicine Physician	036096480	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659372605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER JOHN RIVERA MD

Provider Business Mailing Address
First Line	:	14509 STATE ROUTE 127
Second Line	:
City	:	CARLYLE
State	:	IL
Zip	:	62231-6485
Country	:	US
Telephone Number	:	618-594-3613
Fax Number	:	888-859-4347

Provider Business Practice Location Address
First Line	:	14509 STATE ROUTE 127
Second Line	:
City	:	CARLYLE
State	:	IL
Zip	:	62231-6485
Country	:	US
Telephone Number	:	618-594-3613
Fax Number	:	888-859-4347

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	03/24/2023

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Directions to “ DR. CHRISTOPHER JOHN RIVERA MD” Practice Location

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