Provider Demographics
NPI:1245219641
Name:SCHUBERT, CHARLES BRADLEY (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:BRADLEY
Last Name:SCHUBERT
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 1:1950 N HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60707
Mailing Address - Country:US
Mailing Address - Phone:708-453-6800
Mailing Address - Fax:708-453-3985
Practice Address - Street 1:1950 N HARLEM AVE
Practice Address - Street 2:
Practice Address - City:ELMWOOD PARK
Practice Address - State:IL
Practice Address - Zip Code:60707-3717
Practice Address - Country:US
Practice Address - Phone:708-453-6800
Practice Address - Fax:708-453-3235
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036097485208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36097485Medicaid
IL971720OtherMEDICARE
IL971720OtherMEDICARE