Provider Demographics
NPI:1659372605
Name:RIVERA, CHRISTOPHER JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JOHN
Last Name:RIVERA
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 1:14509 STATE ROUTE 127
Mailing Address - Street 2:
Mailing Address - City:CARLYLE
Mailing Address - State:IL
Mailing Address - Zip Code:62231-6485
Mailing Address - Country:US
Mailing Address - Phone:618-594-3613
Mailing Address - Fax:888-859-4347
Practice Address - Street 1:14509 STATE ROUTE 127
Practice Address - Street 2:
Practice Address - City:CARLYLE
Practice Address - State:IL
Practice Address - Zip Code:62231-6485
Practice Address - Country:US
Practice Address - Phone:618-594-3613
Practice Address - Fax:888-859-4347
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036096480208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036096480Medicaid
ILL74286Medicare ID - Type Unspecified
G96384Medicare UPIN