Individual
CHARLES SAMUEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
280 N WESTGATE RD APT 222, MOUNT PROSPECT, IL 60056-2661
(224) 659-6159
Mailing address
280 N WESTGATE RD APT 222, MOUNT PROSPECT, IL 60056-2661
(224) 659-6159
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209.021993
IL
Other
Enumeration date
09/15/2020
Last updated
09/15/2020
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