Individual
JOSEPH M CHRISTENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
885 ROOSEVELT RD, GLEN ELLYN, IL 60137-6141
(630) 790-1555
(630) 545-3787
Mailing address
885 ROOSEVELT RD, GLEN ELLYN, IL 60137-6141
(630) 790-1555
(630) 545-3787
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036095913
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0222075
BLUE CROSS GROUP NUMBER
IL
05
—
036095913
—
IL
01
—
363149833
TAX IDENTIFICATION NUMBER
IL
01
—
3631498336019001
CDPG HFS PAYEE ID
IL
01
—
487450010
MEDICARE PTAN (INDIVIDUAL)
IL
Enumeration date
07/24/2006
Last updated
04/02/2013
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