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General NPI Number Information
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NPI Number | 1548281470
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Entity Type | Organization
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Legal Business Name | CHARLES DRUECK, M.D., S.C.
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Dates
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Enumeration Date | 07/23/2006
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Last Update Date | 08/27/2009
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Provider Practice Location Address
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Address Line | 5145 N CALIFORNIA AVE
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City | CHICAGO
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State | IL
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Zip | 60625-3661
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Country | US
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Telephone | 773-989-6202
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 388320
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City | CHICAGO
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State | IL
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Zip | 60638-8320
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Country | US
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Telephone | 773-767-4600
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Fax | 773-767-8320
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHARLES DRUECK
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Credential | M.D.
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Telephone | 773-989-6202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 036045746
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License Number State | IL
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