Individual
CHARLES T SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6084 S ARCHER AVE, CHICAGO, IL 60638-2747
(773) 355-2800
Mailing address
6084 S ARCHER AVE, CHICAGO, IL 60638-2747
(773) 355-2800
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036078790
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036078790
—
IL
Enumeration date
07/12/2005
Last updated
03/04/2024
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