Provider Demographics
NPI:1831552876
Name:PARKER, C. WOODWORTH (DO)
Entity type:Individual
Prefix:DR
First Name:C. WOODWORTH
Middle Name:
Last Name:PARKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:CHRISTOPHER
Other - Middle Name:WOODWORTH
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:5833 N SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-3835
Mailing Address - Country:US
Mailing Address - Phone:816-304-1599
Mailing Address - Fax:
Practice Address - Street 1:5645 W ADDISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-2881
Practice Address - Country:US
Practice Address - Phone:773-794-7601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-29
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.172111207P00000X
390200000X
IL125079151207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty