Provider Demographics
NPI:1861484321
Name:COMFORT, CHARLES D (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:D
Last Name:COMFORT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:725 SCHOOL ST STE A
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-1207
Mailing Address - Country:US
Mailing Address - Phone:815-941-9124
Mailing Address - Fax:815-941-4363
Practice Address - Street 1:522 DEPOT ST
Practice Address - Street 2:
Practice Address - City:MAZON
Practice Address - State:IL
Practice Address - Zip Code:60444
Practice Address - Country:US
Practice Address - Phone:815-448-2423
Practice Address - Fax:815-448-2033
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036067046207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036067046Medicaid
IL036067046Medicaid
A45869Medicare UPIN