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NPI Code Detail

MEDICARE: DR. CHARLES ANTHONY CROTTEAU M.D.

MEDICARE: DR. CHARLES ANTHONY CROTTEAU M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician36-095554IL

General Provider Information

NPI Number : 1295757136
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHARLES ANTHONY CROTTEAU M.D.
Provider Business Mailing Address
First Line : 4600 N RAVENSWOOD AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60640-4510
Country : US
Telephone Number : 773-561-7500
Fax Number : 773-561-7612
Provider Business Practice Location Address
First Line : 4600 N RAVENSWOOD AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60640-4510
Country : US
Telephone Number : 773-561-7500
Fax Number : 773-561-7612
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/23/2006
Last Update Date : 12/13/2021

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