MEDICARE: DR. EDWARD STUART CHARLIP

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
1	208D00000X	General Practice Physician	036044376	IL

General Provider Information

NPI Number	:	1649410325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD STUART CHARLIP

Provider Business Mailing Address
First Line	:	141 W JACKSON BLVD STE 2270
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60604-2979
Country	:	US
Telephone Number	:	312-543-9983
Fax Number	:

Provider Business Practice Location Address
First Line	:	141 W JACKSON BLVD
Second Line	:	STE 2270
City	:	CHICAGO
State	:	IL
Zip	:	60604-2929
Country	:	US
Telephone Number	:	312-543-9983
Fax Number	:	312-341-7963

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2009
Last Update Date	:	10/19/2015

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Directions to “ DR. EDWARD STUART CHARLIP ” Practice Location

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