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Organization
PEDIATRIC SPECIALIST OF THE NW MDSC
Active
Organization
PEDIATRIC SPECIALIST OF THE NW MDSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES BRAVERMAN M.D. (AUTHORIZED OFFICIAL)
(843) 381-5005
Entity
Organization
Contact information
Practice address
475 W TERRA COTTA AVE, STE 01, CRYSTAL LAKE, IL 60014-3407
(847) 381-5005
(847) 381-5036
Mailing address
5057 SHORELINE RD, LAKE BARRINGTON, IL 60010-1700
(847) 383-1500
(847) 381-5036
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
IL
Other
Enumeration date
08/01/2005
Last updated
07/21/2022
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