Provider Demographics
NPI:1962619429
Name:WELLS, CHRISTINA DENISE (MD)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:DENISE
Last Name:WELLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2045 W WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-2428
Mailing Address - Country:US
Mailing Address - Phone:312-413-1789
Mailing Address - Fax:312-413-7812
Practice Address - Street 1:7131 S JEFFERY BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-2191
Practice Address - Country:US
Practice Address - Phone:773-256-0526
Practice Address - Fax:312-363-5794
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2013-04-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036121469207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine