Provider Demographics
NPI:1417056904
Name:HUANG, CHARLES L (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:L
Last Name:HUANG
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 1:1275 E BELVIDERE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-2082
Mailing Address - Country:US
Mailing Address - Phone:847-535-7480
Mailing Address - Fax:
Practice Address - Street 1:1275 E BELVIDERE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-2082
Practice Address - Country:US
Practice Address - Phone:847-535-7480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361118982085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036111898Medicaid
IL04915656OtherBLUE SHIELD
IL336074439OtherCONTROLL SUBSTANCE
ILP00255544OtherRR MEDICARE
ILP00255544OtherRR MEDICARE
IL04915656OtherBLUE SHIELD
ILP00255544OtherRR MEDICARE
ILI45418Medicare UPIN
ILK22678Medicare ID - Type Unspecified