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General NPI Number Information
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NPI Number | 1023172392
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Entity Type | Organization
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Legal Business Name | CHARLES R HARRIS & ASSOCIATES LTD
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Dates
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Enumeration Date | 12/21/2006
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Last Update Date | 08/20/2012
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Provider Practice Location Address
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Address Line | 10628 S LONGWOOD DR
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City | CHICAGO
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State | IL
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Zip | 60643-2617
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Country | US
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Telephone | 312-969-4333
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Fax | 773-751-2250
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Provider Business Mailing Address
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Address Line | 10628 S LONGWOOD DR
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City | CHICAGO
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State | IL
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Zip | 60643-2617
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Country | US
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Telephone | 312-969-4333
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Fax | 773-751-2250
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHARLES R HARRIS
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Credential | M.D.
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Telephone | 312-969-4333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 036060209
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License Number State | IL
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