Healthcare Provider Details

I. General information

NPI: 1528058567
Provider Name (Legal Business Name): CHARLES EDWARD KAEGI JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 NORTH PROSPECT AVENUE
PARK RIDGE IL
60068
US

IV. Provider business mailing address

508 NORTH PROSPECT AVENUE
PARK RIDGE IL
60068
US

V. Phone/Fax

Practice location:
  • Phone: 773-282-4387
  • Fax: 888-959-9074
Mailing address:
  • Phone: 773-282-4387
  • Fax: 888-959-9074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036055737
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: