Provider Demographics
NPI:1023097102
Name:CHARNOGURSKY, GERALD (MD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:CHARNOGURSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 S 1ST AVE
Mailing Address - Street 2:(9608 ROBERTS ROAD, HICKORY HILLS, IL. 60457)
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:708-233-5333
Mailing Address - Fax:708-233-5348
Practice Address - Street 1:2160 S 1ST AVE
Practice Address - Street 2:(9608 ROBERTS ROAD, HICKORY HILLS, IL. 60457)
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:708-233-5333
Practice Address - Fax:708-233-5348
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL36064506207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36064506Medicaid
IL902370Medicare ID - Type Unspecified
IL36064506Medicaid