| Doctor Name: | CHARLES T MACDONALD |
| NPI Number: | 1083005961 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 309.0088757 |
| Business Practice Address: | 1752 Windsor Rd 203 Loves Park, IL - 611114280 |
| Business Phone Number: | 8159861113 |
| Business Fax Number: | 8159861119 |
| Mailing Address: | 1752 Windsor Rd, 203 LOVES PARK |
| State: | IL |
| Postal Code: | 611114280 |
| Phone Number: | 8159861113 |
| Fax Number: | 8159861119 |
| NPI Enumeration Date: | 02/12/2015 |
| NPI Last Update Date: | 12/16/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0808X |
| License Number: | 309.0088757 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |