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NPI Code Detail

MEDICARE: DR. CHARLES LAWRENCE CARLTON M.D.

MEDICARE:  DR. CHARLES LAWRENCE CARLTON  M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12081S0010XSports Medicine (Physical Medicine & Rehabilitation) PhysicianIL

General Provider Information

NPI Number : 1619057338
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHARLES LAWRENCE CARLTON M.D.
Provider Business Mailing Address
First Line : 6007 N SHERIDAN RD APT 20A
Second Line :
City : CHICAGO
State : IL
Zip : 60660-3005
Country : US
Telephone Number : 773-561-4977
Fax Number : 773-561-4988
Provider Business Practice Location Address
First Line : 6007 N SHERIDAN RD APT 20A
Second Line :
City : CHICAGO
State : IL
Zip : 60660-3005
Country : US
Telephone Number : 773-561-4977
Fax Number : 773-561-4988
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2006
Last Update Date : 07/08/2007

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Directions to “ DR. CHARLES LAWRENCE CARLTON M.D.” Practice Location

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