Provider Demographics
NPI:1396845848
Name:BRIKHA, CHARLES S (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:S
Last Name:BRIKHA
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 1:8118 N MILWAUKEE AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-2817
Mailing Address - Country:US
Mailing Address - Phone:847-692-5206
Mailing Address - Fax:
Practice Address - Street 1:8118 N MILWAUKEE AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-2817
Practice Address - Country:US
Practice Address - Phone:847-692-5206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-097975207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG89314Medicare UPIN
ILI 19184Medicare UPIN
IL578-00Medicare ID - Type Unspecified