Provider Demographics
NPI:1104243989
Name:BROZ, CHRISTOPHER JAMES (PA-C)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JAMES
Last Name:BROZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 N MICHIGAN AVENUE
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4264
Mailing Address - Country:US
Mailing Address - Phone:312-635-0973
Mailing Address - Fax:813-290-9691
Practice Address - Street 1:401 N MICHIGAN AVE STE 1200
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4264
Practice Address - Country:US
Practice Address - Phone:844-559-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-18
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085005002363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL085005002OtherLICENSE
ILP01322313OtherRAILROAD MEDICARE
ILP01322313OtherRAILROAD MEDICARE