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General NPI Number Information
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NPI Number | 1831552876
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Entity Type | Individual
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Provider Name | C. WOODWORTH PARKER D.O.
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Gender | Male
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Dates
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Enumeration Date | 03/29/2016
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 5645 W ADDISON ST
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City | CHICAGO
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State | IL
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Zip | 60634-2881
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Country | US
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Telephone | 773-794-7601
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Fax |
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Provider Business Mailing Address
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Address Line | 5833 N SHERIDAN RD
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City | CHICAGO
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State | IL
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Zip | 60660-3835
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Country | US
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Telephone | 816-304-1599
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 036.172111
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License Number State | IL
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