Provider Demographics
NPI:1013993104
Name:CAUDILL, CHRISTOPHER C (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:C
Last Name:CAUDILL
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 1:75 REMITTANCE DR
Mailing Address - Street 2:SUITE 1951
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60675-1001
Mailing Address - Country:US
Mailing Address - Phone:847-535-7917
Mailing Address - Fax:847-535-7801
Practice Address - Street 1:660 N WESTMORELAND RD
Practice Address - Street 2:NORTHWESTERN LAKE FOREST HOSPITAL EMERGENCY DEPARTMENT
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1659
Practice Address - Country:US
Practice Address - Phone:847-535-7917
Practice Address - Fax:847-535-7801
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36098229207PE0004X
IL036-098229207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36098229Medicaid
ILL96570Medicare ID - Type Unspecified
IL36098229Medicaid