Individual
DR. CHRISTIAN BAUTISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
155 E BRUSH HILL RD, ELMHURST, IL 60126-5658
(331) 221-1000
Mailing address
255 W MICHIGAN AVE, JACKSON, MI 49201-2218
(517) 787-6440
(517) 787-4146
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
036093126
IL
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
036093126
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036093126
STATE LICENSE
IL
Enumeration date
06/30/2006
Last updated
09/20/2024
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