Provider Demographics
NPI:1063509875
Name:APPLESON, CHARLENE (MD)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:
Last Name:APPLESON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHARLENE
Other - Middle Name:
Other - Last Name:WEISBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1715 W ALGONQUIN RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-5401
Mailing Address - Country:US
Mailing Address - Phone:847-725-8110
Mailing Address - Fax:847-725-8115
Practice Address - Street 1:1715 W ALGONQUIN RD
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-5401
Practice Address - Country:US
Practice Address - Phone:847-725-8110
Practice Address - Fax:847-725-8115
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036055877208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036055877Medicaid