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General NPI Number Information
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NPI Number | 1982878856
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Entity Type | Organization
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Legal Business Name | DR.CHARLES CLIFFORD ALSTON SC
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Dates
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Enumeration Date | 04/22/2008
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Last Update Date | 03/31/2016
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Provider Practice Location Address
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Address Line | 2017 W 95TH ST
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City | CHICAGO
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State | IL
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Zip | 60643-1115
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Country | US
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Telephone | 773-779-2280
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Fax |
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Provider Business Mailing Address
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Address Line | 2017 W 95TH ST
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City | CHICAGO
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State | IL
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Zip | 60643-1115
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. CHARLES ALSTON
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Credential |
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Telephone | 773-779-2801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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