Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 036-113222 | IL |
NPI | 1013909134 |
---|---|
Provider Name | Dr. Stephen L Carter |
First Address | Chicago, IL 60647-4562 |
Second Address | Chicago, IL 60647-4562 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2005 |
Last Update Date | 08/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I29038 | (02) | IL |
P00232723 | RAILROAD MEDICARE (01) | IL |