Provider Demographics
NPI:1750580718
Name:PICA, CHRISTINA MARIE (DO)
Entity type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:MARIE
Last Name:PICA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:FAIRBURY
Mailing Address - State:IL
Mailing Address - Zip Code:61739-1415
Mailing Address - Country:US
Mailing Address - Phone:314-452-2146
Mailing Address - Fax:
Practice Address - Street 1:ST FRANCIS MEDICAL CENTER, DEPT OF PEDIATRICS
Practice Address - Street 2:530 NE GLEN OAK AVENUE
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61637-0001
Practice Address - Country:US
Practice Address - Phone:309-655-2274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.053367208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics