Individual
CHARLES ANTHONY WOODRIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7319 S CHAMPLAIN AVE, CHICAGO, IL 60619-1828
(773) 490-2043
Mailing address
7319 S CHAMPLAIN AVE, CHICAGO, IL 60619-1828
(773) 490-2043
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
036086962
IL
208000000X
Pediatrics Physician
Primary
036086962
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036086962/IL
—
IL
Enumeration date
05/22/2006
Last updated
09/04/2009
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