Organization
CHARLES DRUECK, M.D., S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES DRUECK M.D. (PRESIDENT)
(773) 989-6202
Entity
Organization
Contact information
Practice address
5145 N CALIFORNIA AVE, CHICAGO, IL 60625-3661
(773) 989-6202
Mailing address
PO BOX 388320, CHICAGO, IL 60638-8320
(773) 767-4600
(773) 767-8320
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036045746
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01632718
BLUE SHIELD
IL
01
—
020052114
RAILROAD MEDICARE
—
05
—
036045746
—
IL
Enumeration date
07/23/2006
Last updated
08/27/2009
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