Provider Demographics
NPI:1134115629
Name:STALLTER, CHRISTOPHER (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:STALLTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2972 INDIAN TRAIL RD STE A
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-9408
Mailing Address - Country:US
Mailing Address - Phone:630-499-0812
Mailing Address - Fax:630-499-0823
Practice Address - Street 1:2972 INDIAN TRAIL RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60502-9408
Practice Address - Country:US
Practice Address - Phone:630-499-0812
Practice Address - Fax:630-499-0823
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-089685207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
L87376Medicare ID - Type Unspecified
F92896Medicare UPIN