Provider Demographics
NPI:1023172392
Name:CHARLES R HARRIS & ASSOCIATES LTD
Entity type:Organization
Organization Name:CHARLES R HARRIS & ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:R
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-969-4333
Mailing Address - Street 1:10628 S LONGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-2617
Mailing Address - Country:US
Mailing Address - Phone:312-969-4333
Mailing Address - Fax:773-751-2250
Practice Address - Street 1:10628 S LONGWOOD DR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-2617
Practice Address - Country:US
Practice Address - Phone:312-969-4333
Practice Address - Fax:773-751-2250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360602092084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036060209Medicaid
IL036060209Medicaid