Provider Demographics
NPI:1649410325
Name:CHARLIP, EDWARD STUART
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:STUART
Last Name:CHARLIP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 W JACKSON BLVD STE 2270
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604-2979
Mailing Address - Country:US
Mailing Address - Phone:312-543-9983
Mailing Address - Fax:
Practice Address - Street 1:141 W JACKSON BLVD
Practice Address - Street 2:STE 2270
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-2929
Practice Address - Country:US
Practice Address - Phone:312-543-9983
Practice Address - Fax:312-341-7963
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-20
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036044376208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice