Individual
MR. CHARLES LIONEL GUDE III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
202 W PARK AVE, CHAMPAIGN, IL 61820-3929
(217) 373-2430
Mailing address
202 W PARK AVE, CHAMPAIGN, IL 61820-3929
(217) 373-2430
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
08/19/2010
Last updated
07/01/2011
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