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Organization

PEDIATRIC SPECIALIST OF THE NW MDSC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. CHARLES BRAVERMAN M.D. (AUTHORIZED OFFICIAL)
(843) 381-5005
Entity
Organization

Contact information

Practice address
475 W TERRA COTTA AVE, STE 01, CRYSTAL LAKE, IL 60014-3407
(847) 381-5005
(847) 381-5036
Mailing address
5057 SHORELINE RD, LAKE BARRINGTON, IL 60010-1700
(847) 383-1500
(847) 381-5036

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
IL

Other

Enumeration date
08/01/2005
Last updated
07/21/2022
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