Healthcare Provider Details

I. General information

NPI: 1033323902
Provider Name (Legal Business Name): CHARLES APRAHAMIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 NE GLEN OAK AVE SUITE 201
PEORIA IL
61603-3105
US

IV. Provider business mailing address

420 NE GLEN OAK AVE SUITE 201
PEORIA IL
61603-3105
US

V. Phone/Fax

Practice location:
  • Phone: 309-655-3800
  • Fax: 309-655-3948
Mailing address:
  • Phone: 309-655-3800
  • Fax: 309-655-3948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036130844
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number036130844
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: