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Individual

CHARLES T MORTON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1701 W. CURTIS ROAD, PEDIATRICS, CHAMPAIGN, IL 61822
(217) 365-6202
(217) 326-1234
Mailing address
611 W PARK ST, BWPC, URBANA, IL 61801-2529
(217) 383-6792

Taxonomy

Speciality
Code
Description
License number
State
2080P0006X
Developmental - Behavioral Pediatrics Physician
Primary
036114826
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
DP5951
RR MEDICARE GROUP #
01
IL2613
MEDICARE GROUP PTAN
IL
01
P00820813
RR MEDICARE INDIVIDUAL #
Enumeration date
07/21/2006
Last updated
05/07/2014
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