Provider Demographics
NPI:1669493359
Name:LAHAM, CHARLES L (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:L
Last Name:LAHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1969 WEST HART RD
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-2283
Mailing Address - Country:US
Mailing Address - Phone:608-364-5689
Mailing Address - Fax:608-364-5452
Practice Address - Street 1:BELOIT MEMORIAL HOSPITAL
Practice Address - Street 2:1969 WEST HART RD
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-2283
Practice Address - Country:US
Practice Address - Phone:608-364-5011
Practice Address - Fax:920-320-3049
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI45033-20207RC0000X
WI45033207RC0000X
IA34133207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology