Provider Demographics
NPI:1528563483
Name:CKLAMOVSKI, CHRISTOPHER (DPM, MPH)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:
Last Name:CKLAMOVSKI
Suffix:
Gender:M
Credentials:DPM, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8208 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60480-1010
Mailing Address - Country:US
Mailing Address - Phone:708-630-2017
Mailing Address - Fax:708-398-9777
Practice Address - Street 1:117 W LAKE ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1006
Practice Address - Country:US
Practice Address - Phone:708-630-2017
Practice Address - Fax:708-398-9777
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-24
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1207XX0004X
IL135.000999213ES0103X
IL016.005959213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016.005959OtherLICENSE