Provider Demographics
NPI:1033197637
Name:CHARMAN, MARK J (MD)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:J
Last Name:CHARMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:600 W LAKE COOK RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-2089
Mailing Address - Country:US
Mailing Address - Phone:847-632-1880
Mailing Address - Fax:847-520-6095
Practice Address - Street 1:600 W LAKE COOK RD
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-2089
Practice Address - Country:US
Practice Address - Phone:847-632-1880
Practice Address - Fax:847-520-6095
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036062258207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036062258Medicaid
C42280Medicare UPIN
ILL58119Medicare ID - Type Unspecified