Healthcare Provider Details

I. General information

NPI: 1821090622
Provider Name (Legal Business Name): JOSEPH NEMOURS CARRE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 03/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6415 N CALIFORNIA AVE
CHICAGO IL
60645-5208
US

IV. Provider business mailing address

6415 N CALIFORNIA AVE
CHICAGO IL
60645-5208
US

V. Phone/Fax

Practice location:
  • Phone: 773-262-5400
  • Fax: 773-743-0136
Mailing address:
  • Phone: 773-262-5400
  • Fax: 773-743-0136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number36-065253
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number36-065253
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number36-065253
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: