Individual
CHARONN D WOODS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 RIVERSIDE DR, BOURBONNAIS, IL 60914-4607
(815) 802-7090
(815) 802-7091
Mailing address
100 RIVERSIDE DR, BOURBONNAIS, IL 60914
(815) 802-7090
(815) 802-7091
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
62650
MN
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
01085754A
IN
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
036171703
IL
208VP0000X
Pain Medicine Physician
62650
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001543019
ANTHEM BCBS
IN
05
—
300050075
—
IN
Enumeration date
04/08/2016
Last updated
10/24/2024
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