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General NPI Number Information
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NPI Number | 1609890581
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Entity Type | Individual
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Provider Name | CHARLES DRUECK M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 12/19/2013
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Provider Practice Location Address
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Address Line | 111 YALE CT
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City | GLENVIEW
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State | IL
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Zip | 60026-5916
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Country | US
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Telephone | 847-272-4682
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Fax | 847-272-4691
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Provider Business Mailing Address
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Address Line | 5501 W 79TH ST STE 400
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City | BURBANK
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State | IL
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Zip | 60459-2190
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Country | US
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Telephone | 773-884-4500
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Fax | 773-884-4580
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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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