Individual
DALE ANTHONY CHARLETTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4800 S GREENWOOD AVE, CHICAGO, IL 60615-1914
(312) 315-8046
(312) 284-4800
Mailing address
4800 S GREENWOOD AVE, CHICAGO, IL 60615-1914
(312) 315-8046
(312) 284-4800
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
036072329
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036072329
—
IL
01
—
1615479
BCBBS
—
01
—
300127675
RR MC
—
01
—
CN0576
GROUP #
—
Enumeration date
02/17/2006
Last updated
10/21/2016
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