Provider Demographics
NPI:1134172299
Name:CHARLES W PARRISH III
Entity type:Organization
Organization Name:CHARLES W PARRISH III
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:PARRISH
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:847-215-7889
Mailing Address - Street 1:601 MARSEILLES CIR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-7719
Mailing Address - Country:US
Mailing Address - Phone:847-215-7889
Mailing Address - Fax:
Practice Address - Street 1:601 MARSEILLES CIR
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-7719
Practice Address - Country:US
Practice Address - Phone:847-215-7889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL623930Medicare ID - Type Unspecified