Provider Demographics
NPI:1679657548
Name:CHARLES, FRANTZ ANTOINE (MD)
Entity Type:Individual
Prefix:
First Name:FRANTZ
Middle Name:ANTOINE
Last Name:CHARLES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 378
Mailing Address - Street 2:SPARTA COMMUNITY HOSPITAL
Mailing Address - City:SPARTA
Mailing Address - State:IL
Mailing Address - Zip Code:62286
Mailing Address - Country:US
Mailing Address - Phone:618-443-2177
Mailing Address - Fax:618-443-1358
Practice Address - Street 1:818 EAST BROADWAY
Practice Address - Street 2:SPARTA COMMUNITY HOSPITAL
Practice Address - City:SPARTA
Practice Address - State:IL
Practice Address - Zip Code:62286
Practice Address - Country:US
Practice Address - Phone:618-443-2177
Practice Address - Fax:618-443-1358
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC45731Medicare UPIN