Provider Demographics
NPI:1124004585
Name:GOETZ, CHRISTOPHER GRAVES (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:GRAVES
Last Name:GOETZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1725 W HARRISON
Mailing Address - Street 2:#755 UNIVERSITY NEUROLOGISTS SECT OF MOVEMENT DISORDERS
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3824
Mailing Address - Country:US
Mailing Address - Phone:312-942-2900
Mailing Address - Fax:312-563-2024
Practice Address - Street 1:1725 W HARRISON
Practice Address - Street 2:#755 NEUROSCIENCE INSTITUTE SECT OF MOVEMENT DISORDERS
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3824
Practice Address - Country:US
Practice Address - Phone:312-563-2030
Practice Address - Fax:312-563-2684
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL0360535652084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036053565Medicaid
IL336018292OtherCS IL DEPT OF PROF REG
BG2845773OtherDEA DEPT OF JUSTICE
IL036053565Medicaid
ILL60622Medicare ID - Type UnspecifiedCMS WPS