Provider Demographics
NPI:1114025483
Name:JAMES, CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:JAMES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 S. DAMEN AVE.
Mailing Address - Street 2:JESSE BROWN VAMC; DEPARTMENT OF RADIOLOGY
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3728
Mailing Address - Country:US
Mailing Address - Phone:312-569-7735
Mailing Address - Fax:312-569-8102
Practice Address - Street 1:JESSE BROWN VAMC; 820 S. DAMEN AVE.
Practice Address - Street 2:DEPARTMENT OF RADIOLOGY; ROOM NUMBER 4436
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3728
Practice Address - Country:US
Practice Address - Phone:312-569-7735
Practice Address - Fax:312-569-8102
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-063788171000000X
IL336-0282412085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology