Provider Demographics
NPI:1073623112
Name:CHARLES J OLAUGHLIN JR MD SC
Entity Type:Organization
Organization Name:CHARLES J OLAUGHLIN JR MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:J
Authorized Official - Last Name:O'LAUGHLIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:847-364-7717
Mailing Address - Street 1:800 BIESTERFIELD RD
Mailing Address - Street 2:SUITE 4009, BROCK BLDG
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3311
Mailing Address - Country:US
Mailing Address - Phone:847-364-7717
Mailing Address - Fax:847-364-7748
Practice Address - Street 1:800 BIESTERFIELD RD
Practice Address - Street 2:SUITE 4009, BROCK BLDG
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3311
Practice Address - Country:US
Practice Address - Phone:847-364-7717
Practice Address - Fax:847-364-7748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-053819207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL602320OtherMEDICARE
IL036053819Medicaid
2692561OtherCAQH
4388872OtherAETNA INS
036-053819OtherILL LICENSE
CAC34698OtherLICENSE
CAC34698OtherLICENSE
IL602320OtherMEDICARE