Individual
CHRISTOPHER JOHN BERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5 KISH HOSPITAL DR STE 103, DEKALB, IL 60115-9602
(630) 232-0280
(630) 315-1339
Mailing address
5 KISH HOSPITAL DR STE 103, DEKALB, IL 60115-9602
(630) 232-0280
(630) 315-1339
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036-101679
IL
207RC0000X
Cardiovascular Disease Physician
36039
IA
207RI0011X
Interventional Cardiology Physician
Primary
036-101679
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036101679
—
IL
01
—
206147
MEDICARE PTAN (GROUP)
IL
01
—
F400124149
MEDICARE PTAN (INDIVIDUAL)
IL
Enumeration date
10/27/2006
Last updated
04/25/2023
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