Provider Demographics
NPI:1629363270
Name:FLOREANI, CHRISTINA VERA
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:VERA
Last Name:FLOREANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 S EAST AVE
Mailing Address - Street 2:APT 3
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2983
Mailing Address - Country:US
Mailing Address - Phone:773-614-2032
Mailing Address - Fax:
Practice Address - Street 1:420 S AHRENS AVE
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-3006
Practice Address - Country:US
Practice Address - Phone:773-916-7595
Practice Address - Fax:866-339-5811
Is Sole Proprietor?:No
Enumeration Date:2011-06-12
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.1337972084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400392146OtherMEDICARE
IL036133797Medicaid