Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0202X | Pediatric Cardiologist | 0101102544 | VA |
Y | 2080P0202X | Pediatric Cardiologist | 036130481 | IL |
NPI | 1285770925 |
---|---|
Provider Name | Dr. Michael R Carr |
First Address | Chicago, IL 60611 |
Second Address | Chicago, IL 60611 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2007 |
Last Update Date | 05/07/2012 |