Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 036150166 | IL |
NPI | 1053677005 |
---|---|
Provider Name | Carrie Allison Mcilwain |
First Address | Oak Lawn, IL 60453-2416 |
Second Address | Oak Lawn, IL 60453-2416 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2012 |
Last Update Date | 23/07/2019 |