Individual
MR. CHARLES ROY KNUDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
675 N SAINT CLAIR ST STE 19-100, CHICAGO, IL 60611-5969
(312) 664-3278
(312) 695-5774
Mailing address
675 N SAINT CLAIR ST STE 19-100, CHICAGO, IL 60611-5969
(312) 664-3278
(312) 695-5774
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-07298
NC
363A00000X
Physician Assistant
Primary
085004374
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085004374
ILLINOIS PHYSICIAN ASSISTANT LICENSE NUMBER
IL
Enumeration date
08/02/2012
Last updated
11/08/2024
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