Provider Demographics
NPI:1285628982
Name:JAFFE, CHARLES E (DO)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
Last Name:JAFFE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 TOWER CT
Mailing Address - Street 2:STE F
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-5712
Mailing Address - Country:US
Mailing Address - Phone:847-360-8440
Mailing Address - Fax:847-360-8468
Practice Address - Street 1:35 TOWER CT
Practice Address - Street 2:STE F
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-5712
Practice Address - Country:US
Practice Address - Phone:847-360-8440
Practice Address - Fax:847-360-8468
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036100907207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2326153OtherMPIN
IL7412520OtherAETNA
IL036100907Medicaid
IL036100907Medicaid
IL205617Medicare ID - Type Unspecified