Provider Demographics
NPI:1669506390
Name:CARDOZO, CHARMAINE M (MD)
Entity Type:Individual
Prefix:MRS
First Name:CHARMAINE
Middle Name:M
Last Name:CARDOZO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 WASHINGTON BLVD
Mailing Address - Street 2:#204
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-4066
Mailing Address - Country:US
Mailing Address - Phone:708-738-2494
Mailing Address - Fax:
Practice Address - Street 1:9830 RIDGELAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60415-2667
Practice Address - Country:US
Practice Address - Phone:708-636-8747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-1156582080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-115658OtherPROFESSIONAL