Individual
CHARLES SLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
150 N MICHIGAN AVE, SUITE 1400, CHICAGO, IL 60601-7553
(312) 444-1145
Mailing address
900 RAND RD STE 300, ATTN: RAQUEL LEON, DES PLAINES, IL 60016-2359
(847) 324-3976
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
036-048353
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036-048353
—
IL
Enumeration date
05/24/2006
Last updated
08/28/2012
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