Provider Demographics
NPI:1568586733
Name:CRISTINA S BROTEA M D SC
Entity Type:Organization
Organization Name:CRISTINA S BROTEA M D SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BROTEA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-301-7595
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL210486Medicare UPIN
ILH91491Medicare UPIN