Provider Demographics
NPI:1386702595
Name:BOWERS, CHRISTINE (MD)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:
Last Name:BOWERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4719 N SHERIDAN ROAD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614
Mailing Address - Country:US
Mailing Address - Phone:309-685-7245
Mailing Address - Fax:309-685-7247
Practice Address - Street 1:4719 N SHERIDAN ROAD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614
Practice Address - Country:US
Practice Address - Phone:309-685-7245
Practice Address - Fax:309-685-7247
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360735902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036073590Medicaid
E44411Medicare UPIN
922751Medicare ID - Type Unspecified