Individual
DR. CHARLES KITCHEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1187 WILMETTE AVE, #340, WILMETTE, IL 60091-2719
(312) 236-0990
(847) 251-5147
Mailing address
1187 WILMETTE AVE, #340, WILMETTE, IL 60091-2719
(312) 236-0990
(847) 251-5147
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21605259
BLUE CROSS BLUE SHIELD
IL
Enumeration date
07/21/2005
Last updated
12/31/2007
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