Provider Demographics
NPI:1225144306
Name:VANDENBOSCH, CHRISTINA E (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:E
Last Name:VANDENBOSCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SALT CREEK LN STE 125
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-2902
Mailing Address - Country:US
Mailing Address - Phone:630-655-1177
Mailing Address - Fax:630-655-1192
Practice Address - Street 1:11 SALT CREEK LN STE 125
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-2902
Practice Address - Country:US
Practice Address - Phone:630-655-1177
Practice Address - Fax:630-655-1192
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2232216OtherBC/BS OF IL PROVIDER #
IL2232216OtherBC/BS OF IL PROVIDER #
ILG38203Medicare UPIN