Provider Demographics
NPI:1215307798
Name:CHARLES GALANIS MDSC
Entity type:Organization
Organization Name:CHARLES GALANIS MDSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:GALANIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-995-9822
Mailing Address - Street 1:845 N STATE ST
Mailing Address - Street 2:SUITE 3406
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-3324
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:330 W FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-3467
Practice Address - Country:US
Practice Address - Phone:847-441-4441
Practice Address - Fax:847-784-9744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-28
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036133545208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty