Provider Demographics
NPI:1629962212
Name:MAGGIO, CHRISTIAN JOSEPH
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:JOSEPH
Last Name:MAGGIO
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 1:1502 E GREENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-1510
Mailing Address - Country:US
Mailing Address - Phone:847-848-7132
Mailing Address - Fax:
Practice Address - Street 1:1502 E GREENWOOD DR
Practice Address - Street 2:
Practice Address - City:MT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-1510
Practice Address - Country:US
Practice Address - Phone:847-848-7132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-06
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program