Healthcare Provider Details

I. General information

NPI: 1417056904
Provider Name (Legal Business Name): CHARLES L HUANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 E BELVIDERE RD SUITE 200
GRAYSLAKE IL
60030-2082
US

IV. Provider business mailing address

1275 E BELVIDERE RD SUITE 200
GRAYSLAKE IL
60030-2082
US

V. Phone/Fax

Practice location:
  • Phone: 847-535-7480
  • Fax:
Mailing address:
  • Phone: 847-535-7480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036111898
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: