Provider Demographics
NPI:1164534137
Name:CAUGHRON, MICHAEL CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CHARLES
Last Name:CAUGHRON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 COMPASS RD
Mailing Address - Street 2:#100
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-8000
Mailing Address - Country:US
Mailing Address - Phone:847-901-5200
Mailing Address - Fax:847-904-4913
Practice Address - Street 1:2501 COMPASS RD
Practice Address - Street 2:#100
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-8000
Practice Address - Country:US
Practice Address - Phone:847-901-5200
Practice Address - Fax:847-904-4913
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036070040207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1912186024OtherGROUP NPI
IL036070040Medicaid
IL216024OtherGROUP PTAN
IL216024OtherGROUP PTAN
IL1912186024OtherGROUP NPI
IL756600Medicare ID - Type Unspecified