Individual
CHARLES SWEENEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
612 ROXBURY RD, ROCKFORD, IL 61107-5089
(815) 227-8300
(815) 227-8301
Mailing address
612 ROXBURY RD, ROCKFORD, IL 61107-5089
(815) 227-8300
(815) 227-8301
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
036072316
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036072316
—
IL
01
—
1616108
BCBS
IL
05
—
31763600
—
WI
01
—
P00605022
RAILROAD MEDICARE
IL
Enumeration date
08/11/2005
Last updated
04/22/2011
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