MEDICARE: MR. CHRISTOPHER A BOUTIN 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	207RG0100X	Gastroenterology Physician	036-109037	IL

General Provider Information

NPI Number	:	1760440259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRISTOPHER A BOUTIN MD

Provider Business Mailing Address
First Line	:	4201 WINFIELD RD FL 4
Second Line	:
City	:	WARRENVILLE
State	:	IL
Zip	:	60555-4025
Country	:	US
Telephone Number	:	331-221-6377
Fax Number	:	331-221-2357

Provider Business Practice Location Address
First Line	:	133 E BRUSH HILL RD STE 310
Second Line	:
City	:	ELMHURST
State	:	IL
Zip	:	60126-5662
Country	:	US
Telephone Number	:	331-221-9003
Fax Number	:	331-221-2743

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	05/26/2021

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Directions to “ MR. CHRISTOPHER A BOUTIN MD” Practice Location

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