Healthcare Provider Details

I. General information

NPI: 1821040841
Provider Name (Legal Business Name): CHARLES STRULOVITCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5145 N CALIFORNIA AVE
CHICAGO IL
60625-3661
US

IV. Provider business mailing address

PO BOX 5940
CAROL STREAM IL
60197-5940
US

V. Phone/Fax

Practice location:
  • Phone: 773-878-8200
  • Fax:
Mailing address:
  • Phone: 630-734-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number036065944
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036065944
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: