Provider Demographics
NPI:1881649697
Name:CHRISTY, GEORGE WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:WILLIAM
Last Name:CHRISTY
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 1:22285 N PEPPER RD STE 103
Mailing Address - Street 2:
Mailing Address - City:LAKE BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-2539
Mailing Address - Country:US
Mailing Address - Phone:224-357-8133
Mailing Address - Fax:847-717-7313
Practice Address - Street 1:22285 N PEPPER RD
Practice Address - Street 2:
Practice Address - City:LAKE BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-2538
Practice Address - Country:US
Practice Address - Phone:224-357-8133
Practice Address - Fax:224-357-8048
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036105490207RI0011X, 207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036105490Medicaid
IN200945490AMedicaid
IL200945490BMedicaid
IL0001628870OtherBC/BS
ILIL6032001Medicare PIN
IL200945490BMedicaid
IL0001628870OtherBC/BS
IL036105490Medicaid
ILIL1651001Medicare PIN