Provider Demographics
NPI:1699308718
Name:COLLIER, CHRISTOPHER R
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:R
Last Name:COLLIER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2439 N FRANCISCO AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-0676
Mailing Address - Country:US
Mailing Address - Phone:302-598-2887
Mailing Address - Fax:
Practice Address - Street 1:3333 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064-3037
Practice Address - Country:US
Practice Address - Phone:847-578-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program