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NPI Code Detail

MEDICARE: DR. C. WOODWORTH PARKER D.O.

MEDICARE: DR. C. WOODWORTH PARKER D.O.
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
1207P00000XEmergency Medicine Physician036.172111IL

General Provider Information

NPI Number : 1831552876
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. C. WOODWORTH PARKER D.O.
Provider Business Mailing Address
First Line : 5833 N SHERIDAN RD
Second Line :
City : CHICAGO
State : IL
Zip : 60660-3835
Country : US
Telephone Number : 816-304-1599
Fax Number :
Provider Business Practice Location Address
First Line : 5645 W ADDISON ST
Second Line :
City : CHICAGO
State : IL
Zip : 60634-2881
Country : US
Telephone Number : 773-794-7601
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2016
Last Update Date : 11/18/2024

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