Provider Demographics
NPI:1376511345
Name:GUERRERO, CHRISTOPHER (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:
Last Name:GUERRERO
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 1:3939 N OCTAVIA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-3517
Mailing Address - Country:US
Mailing Address - Phone:773-772-7922
Mailing Address - Fax:773-772-7982
Practice Address - Street 1:1431 N WESTERN AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-1797
Practice Address - Country:US
Practice Address - Phone:773-772-7922
Practice Address - Fax:773-772-7982
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2014-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036062100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL316-0064379OtherBLUE CROSS BLUE SHIELD
IL036062100Medicaid
686200Medicare PIN
IL036062100Medicaid