Provider Demographics
NPI:1063525814
Name:HILLENBRAND, CHARLES REYNOLD (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:REYNOLD
Last Name:HILLENBRAND
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 1:800 BIESTERFIELD ROAD
Mailing Address - Street 2:SUITE 3005
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3364
Mailing Address - Country:US
Mailing Address - Phone:847-437-7172
Mailing Address - Fax:
Practice Address - Street 1:800 BIESTERFIELD ROAD
Practice Address - Street 2:SUITE 3005
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3364
Practice Address - Country:US
Practice Address - Phone:847-437-7172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2013-02-18
Deactivation Date:2007-08-06
Deactivation Code:
Reactivation Date:2013-01-17
Provider Licenses
StateLicense IDTaxonomies
IL0360444842084P0800X
IN01024085A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036044484Medicaid