Provider Demographics
NPI:1992448088
Name:DEMERS, CHRISTOPHER J
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:J
Last Name:DEMERS
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 1:5254 S DORCHESTER AVE APT 114
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-4125
Mailing Address - Country:US
Mailing Address - Phone:734-693-0961
Mailing Address - Fax:
Practice Address - Street 1:7450 W 63RD ST
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:IL
Practice Address - Zip Code:60501-1816
Practice Address - Country:US
Practice Address - Phone:708-458-0757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-15
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.025570367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife