Provider Demographics
NPI:1346364502
Name:BROTEA, CRISTINA S (MD)
Entity Type:Individual
Prefix:DR
First Name:CRISTINA
Middle Name:S
Last Name:BROTEA
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 1:4107 EASY CIR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-4431
Mailing Address - Country:US
Mailing Address - Phone:630-301-7595
Mailing Address - Fax:630-301-7596
Practice Address - Street 1:1300 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-1451
Practice Address - Country:US
Practice Address - Phone:630-301-7595
Practice Address - Fax:630-301-7595
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036107571207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036107571Medicaid
ILK12806Medicare PIN
IL036107571Medicaid