Provider Demographics
NPI:1609901693
Name:CHARLES, ALIX A (MD)
Entity Type:Individual
Prefix:DR
First Name:ALIX
Middle Name:A
Last Name:CHARLES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:68 AMBROGIO DR
Mailing Address - Street 2:STE 103
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3339
Mailing Address - Country:US
Mailing Address - Phone:847-244-0401
Mailing Address - Fax:847-244-0445
Practice Address - Street 1:68 AMBROGIO DR
Practice Address - Street 2:STE 103
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3339
Practice Address - Country:US
Practice Address - Phone:847-244-0401
Practice Address - Fax:847-244-0445
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
C45688Medicare UPIN