Provider Demographics
NPI:1124003843
Name:STORTZUM, CHRISTOPHER DAMIAN (MD)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:DAMIAN
Last Name:STORTZUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-2403
Mailing Address - Country:US
Mailing Address - Phone:217-528-7541
Mailing Address - Fax:217-528-8962
Practice Address - Street 1:505 E GRANT ST
Practice Address - Street 2:SUITE 110
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455-3352
Practice Address - Country:US
Practice Address - Phone:309-833-1733
Practice Address - Fax:309-836-2369
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036113936207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H96169Medicare UPIN
K02713Medicare ID - Type Unspecified