# DOCTOR CHARLES D MULLENIX MD SC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639361504
- **Authorized official:** DR. CHARLES DENNIS MULLENIX (OWNER PRESIDENT)
- **Authorized official phone:** (847) 724-6617

## Contact information

- **Practice address:** 1775 GLENVIEW RD, SUITE 114, GLENVIEW, IL 60025-2975
- **Practice address phone:** (847) 724-6617
- **Practice address fax:** (847) 724-3123
- **Mailing address:** 1775 GLENVIEW RD, SUITE 114, GLENVIEW, IL 60025-2975
- **Mailing address phone:** (847) 724-6617
- **Mailing address fax:** (847) 724-3123

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | — | IL | Yes |

## Other

- **Enumeration date:** 08/15/2007
- **Last updated:** 03/07/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 01605282 | BLUE CROSS | — |
| 01 | — | 0538000001 | DMERC | — |
| 01 | — | 4028871 | AETNA | — |