Provider Demographics
NPI:1417501875
Name:CHRISTOPHER WOMACK, MD LLC
Entity Type:Organization
Organization Name:CHRISTOPHER WOMACK, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:WOMACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:224-306-1879
Mailing Address - Street 1:PO BOX 506
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60065-0506
Mailing Address - Country:US
Mailing Address - Phone:224-306-1879
Mailing Address - Fax:224-205-3757
Practice Address - Street 1:60 REVERE DR STE 100
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1590
Practice Address - Country:US
Practice Address - Phone:224-306-1879
Practice Address - Fax:224-205-3757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty