Provider Demographics
NPI:1720029267
Name:CHRISTISON, AMY (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:CHRISTISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7801 N KNOXVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-2076
Mailing Address - Country:US
Mailing Address - Phone:309-692-6088
Mailing Address - Fax:309-692-0502
Practice Address - Street 1:7801 N KNOXVILLE AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-2076
Practice Address - Country:US
Practice Address - Phone:309-692-6088
Practice Address - Fax:309-692-0502
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0360802051Medicaid
IL472310OtherHEALTHLINK
IL7215059Other7215059
IL008433OtherHEALTH ALLIANCE
ILIL0112OtherJOHN DEERE