Healthcare Provider Details

I. General information

NPI: 1760433726
Provider Name (Legal Business Name): CARTER S YOUNG D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 RELIABLE PARKWAY
CHICAGO IL
60686-0001
US

IV. Provider business mailing address

411 HAMILTON BLVD SUITE 1824
PEORIA IL
61602-1144
US

V. Phone/Fax

Practice location:
  • Phone: 309-671-8748
  • Fax: 309-671-8740
Mailing address:
  • Phone: 309-494-9320
  • Fax: 309-494-9321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: