MEDICARE: DR.CHARLES CLIFFORD ALSTON SC

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
1	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1982878856
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR.CHARLES CLIFFORD ALSTON SC

Provider Business Mailing Address
First Line	:	2017 W 95TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-1115
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2017 W 95TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-1115
Country	:	US
Telephone Number	:	773-779-2280
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. CHARLES ALSTON
Credential	:
Telephone Number	:	773-779-2801

Provider Enumeration Date	:	04/22/2008
Last Update Date	:	03/31/2016

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Directions to “DR.CHARLES CLIFFORD ALSTON SC ” Practice Location

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