Healthcare Provider Details

I. General information

NPI: 1023249075
Provider Name (Legal Business Name): CARLETHA CAROL HUGHES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 11/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9016 S. CORNELL AVENUE
CHICAGO IL
60617-3504
US

IV. Provider business mailing address

9016 S CORNELL AVE
CHICAGO IL
60617-3504
US

V. Phone/Fax

Practice location:
  • Phone: 773-983-3948
  • Fax:
Mailing address:
  • Phone: 773-983-3948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125053483
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: