Individual
CHARLES HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2750 W NORTH AVE, CHICAGO, IL 60647-5247
(312) 666-3494
Mailing address
156 W SUPERIOR ST APT 301, CHICAGO, IL 60654-8761
(312) 208-5178
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036-112117
IL
207P00000X
Emergency Medicine Physician
A74170
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036112117
—
IL
Enumeration date
07/17/2006
Last updated
12/22/2008
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