Healthcare Provider Details

I. General information

NPI: 1134172299
Provider Name (Legal Business Name): CHARLES W PARRISH III
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 MARSEILLES CIR
BUFFALO GROVE IL
60089-7719
US

IV. Provider business mailing address

601 MARSEILLES CIR
BUFFALO GROVE IL
60089-7719
US

V. Phone/Fax

Practice location:
  • Phone: 847-215-7889
  • Fax:
Mailing address:
  • Phone: 847-215-7889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: CHARLES W PARRISH III
Title or Position: CEO
Credential: MD
Phone: 847-215-7889