Charletta, Dale Anthony

Charletta, Dale Anthony is an individual health care provider with primary practice located at 4800 S Greenwood Ave , Chicago IL 60615-1914. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Charletta, Dale Anthony can be contacted via phone (312) 315-8046.

Contact Information

Primary practice address
4800 S Greenwood Ave Chicago IL 60615-1914
Phone: (312) 315-8046
Fax: (312) 284-4800
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 036072329 Illinois

Profile Details

NPI number 1164497731
LBN Legal business name Charletta, Dale Anthony
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 17th, 2006
Last updated Oct 21st, 2016 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1164497731 NPPES
Other 1615479 BCBBS
Other 300127675 BCBBS
Other CN0576 BCBBS
MEDICAID 036072329 BCBBS

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