Provider Demographics
NPI:1922040351
Name:VITTORI, CHRISTOPHER MICHAEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:VITTORI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15750 S BELL RD
Mailing Address - Street 2:SUITE 2E
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-8412
Mailing Address - Country:US
Mailing Address - Phone:708-301-4443
Mailing Address - Fax:708-301-4413
Practice Address - Street 1:15750 S BELL RD
Practice Address - Street 2:SUITE 2E
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-8412
Practice Address - Country:US
Practice Address - Phone:708-301-4443
Practice Address - Fax:708-301-4413
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005195213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016005195Medicaid
ILP00247809OtherRAILROAD MEDICARE
IL0001635273OtherBCBS
ILP00411493OtherRAILROAD MEDICARE
IL1633823OtherBCBS
IL5914500001Medicare NSC
ILK21763Medicare PIN
IL016005195Medicaid
ILV04926Medicare UPIN