Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 6618 | KS |
NPI | 1033249677 |
---|---|
Provider Name | Cara Beth Garretson |
First Address | Chicago, IL 60202 |
Second Address | Chicago, IL 60642 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2007 |
Last Update Date | 04/01/2011 |