Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 036.130085 | IL |
N | 207N00000X | Dermatologist | A116000 | CA |
N | 207ND0101X | MOHS-Micrographic Surgeon | 036.130085 | IL |
NPI | 1285830166 |
---|---|
Provider Name | Dr. Jordan Claire Carqueville |
First Address | Chicago, IL 60611-4451 |
Second Address | Chicago, IL 60611-4451 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2007 |
Last Update Date | 11/11/2020 |