Provider Demographics
NPI:1841299732
Name:KITCHEN, CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:KITCHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1187 WILMETTE AVE
Mailing Address - Street 2:#340
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2719
Mailing Address - Country:US
Mailing Address - Phone:312-236-0990
Mailing Address - Fax:847-251-5147
Practice Address - Street 1:1187 WILMETTE AVE
Practice Address - Street 2:#340
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2719
Practice Address - Country:US
Practice Address - Phone:312-236-0990
Practice Address - Fax:847-251-5147
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21605259OtherBLUE CROSS BLUE SHIELD
IL480560Medicare PIN
ILC42076Medicare UPIN