Provider Demographics
NPI:1508973918
Name:HALBECK, CHARLES S (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:S
Last Name:HALBECK
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 1:915 E. 5TH ST.
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-6471
Mailing Address - Country:US
Mailing Address - Phone:618-463-5300
Mailing Address - Fax:618-463-5195
Practice Address - Street 1:915 E. 5TH ST.
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-6471
Practice Address - Country:US
Practice Address - Phone:618-463-5300
Practice Address - Fax:618-463-5195
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036061328208D00000X
MOR2F64208D00000X
IL036.061328208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL384230003Medicare UPIN