Provider Demographics
NPI:1609890581
Name:DRUECK, CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:DRUECK
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 1:5501 W 79TH ST STE 400
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:IL
Mailing Address - Zip Code:60459-2190
Mailing Address - Country:US
Mailing Address - Phone:773-884-4500
Mailing Address - Fax:773-884-4580
Practice Address - Street 1:111 YALE CT
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-5916
Practice Address - Country:US
Practice Address - Phone:847-272-4682
Practice Address - Fax:847-272-4691
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036045746208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
020052114OtherRAILROAD MEDICARE
IL01632718OtherBLUE SHIELD
IL036045746Medicaid
IL201389Medicare ID - Type Unspecified
IL036045746Medicaid