Healthcare Provider Details

I. General information

NPI: 1316642010
Provider Name (Legal Business Name): JACQUES CHRISTIAN CHARLIER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2734 W 87TH ST
CHICAGO IL
60652-3937
US

IV. Provider business mailing address

1745 BEDFORD SQUARE DR
ROCHESTER HILLS MI
48306-4469
US

V. Phone/Fax

Practice location:
  • Phone: 773-918-4700
  • Fax:
Mailing address:
  • Phone: 978-242-2762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036180807
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: