Provider Demographics
NPI:1023249075
Name:HUGHES, CARLETHA CAROL (MD)
Entity type:Individual
Prefix:DR
First Name:CARLETHA
Middle Name:CAROL
Last Name:HUGHES
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 1:9016 S CORNELL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-3504
Mailing Address - Country:US
Mailing Address - Phone:773-983-3948
Mailing Address - Fax:
Practice Address - Street 1:9016 S. CORNELL AVENUE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-3504
Practice Address - Country:US
Practice Address - Phone:773-983-3948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125053483208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics