MEDICARE: DR. CAROL KAY THARP MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician		IL

General Provider Information

NPI Number	:	1811988397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROL KAY THARP MD

Provider Business Mailing Address
First Line	:	840 GREEN BAY RD
Second Line	:
City	:	WINNETKA
State	:	IL
Zip	:	60093-1864
Country	:	US
Telephone Number	:	847-446-7996
Fax Number	:	847-446-7926

Provider Business Practice Location Address
First Line	:	840 GREEN BAY RD
Second Line	:
City	:	WINNETKA
State	:	IL
Zip	:	60093-1864
Country	:	US
Telephone Number	:	847-446-7996
Fax Number	:	847-446-7926

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	02/07/2008

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