Provider Demographics
NPI:1518065341
Name:STANDAGE, CHRISTOPHER B (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:B
Last Name:STANDAGE
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 1:2441 LAKE SHORE DRIVE
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-6911
Mailing Address - Country:US
Mailing Address - Phone:815-338-4600
Mailing Address - Fax:815-338-4611
Practice Address - Street 1:2441 LAKE SHORE DRIVE
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-6911
Practice Address - Country:US
Practice Address - Phone:815-338-4600
Practice Address - Fax:815-338-4611
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036092552207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036092552Medicaid
G24476Medicare UPIN
ILK19258Medicare ID - Type UnspecifiedLOCALITY 99
ILK19259Medicare ID - Type UnspecifiedLOCALITY 15
ILCN5830Medicare PIN
IL040016675Medicare PIN
IL040010068Medicare PIN
ILCB6770Medicare PIN