Provider Demographics
NPI:1356324867
Name:LAWLER, CHARLES (MD)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:
Last Name:LAWLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2525 S MICHIGAN AVE
Mailing Address - Street 2:B-390
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2333
Mailing Address - Country:US
Mailing Address - Phone:312-567-6691
Mailing Address - Fax:312-328-7895
Practice Address - Street 1:3700 S WALLACE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60609-1745
Practice Address - Country:US
Practice Address - Phone:773-247-1900
Practice Address - Fax:773-247-8892
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036078328207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01621679OtherBCBS OF IL
IL036078328 /02Medicaid
IL426240Medicare ID - Type UnspecifiedGROUP 950150
IL01621679OtherBCBS OF IL