Healthcare Provider Details

I. General information

NPI: 1013957760
Provider Name (Legal Business Name): CARL B TOREN MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9119 S EXCHANGE AVE
CHICAGO IL
60617-4225
US

IV. Provider business mailing address

9119 S EXCHANGE AVE
CHICAGO IL
60617-4225
US

V. Phone/Fax

Practice location:
  • Phone: 773-768-5000
  • Fax: 773-768-7706
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number336035741
License Number StateIL

VIII. Authorized Official

Name: WENDY COX
Title or Position: CEO
Credential:
Phone: 773-768-5000