Provider Demographics
NPI:1558349514
Name:CHELICH, CHARLES MATTHEW (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:MATTHEW
Last Name:CHELICH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:71 W 156TH STREET
Mailing Address - Street 2:SUITE 305
Mailing Address - City:HARVEY
Mailing Address - State:IL
Mailing Address - Zip Code:60426-4264
Mailing Address - Country:US
Mailing Address - Phone:708-331-0011
Mailing Address - Fax:815-331-0008
Practice Address - Street 1:16240 PRINCE DR
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-3233
Practice Address - Country:US
Practice Address - Phone:708-331-0011
Practice Address - Fax:708-331-0008
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036078091207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1627644OtherBCBS
IL1627644OtherBCBS
E23666Medicare UPIN