Provider Demographics
NPI:1134227259
Name:ZUGERMAN, CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:ZUGERMAN
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 1:201 E HURON ST
Mailing Address - Street 2:STE 11-250
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2968
Mailing Address - Country:US
Mailing Address - Phone:312-337-4020
Mailing Address - Fax:312-587-9001
Practice Address - Street 1:1 E DELAWARE PL
Practice Address - Street 2:STE 501
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-1666
Practice Address - Country:US
Practice Address - Phone:312-626-1759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3650426207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL031600045OtherBLUE CROSS NUMBER
IL03650426Medicaid
IL363181347Medicare UPIN
IL03650426Medicaid