Healthcare Provider Details

I. General information

NPI: 1245219641
Provider Name (Legal Business Name): CHARLES BRADLEY SCHUBERT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 04/27/2022
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 N HARLEM AVE
ELMWOOD PARK IL
60707-3717
US

IV. Provider business mailing address

1950 N HARLEM AVE
ELMWOOD PARK IL
60707
US

V. Phone/Fax

Practice location:
  • Phone: 708-453-6800
  • Fax: 708-453-3235
Mailing address:
  • Phone: 708-453-6800
  • Fax: 708-453-3985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036097485
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number036097485
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: