Healthcare Provider Details

I. General information

NPI: 1982757993
Provider Name (Legal Business Name): CARRIE A. JAWORSKI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2007
Last Update Date: 02/10/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2180 PFINGSTEN RD STE 3100
GLENVIEW IL
60026
US

IV. Provider business mailing address

2180 PFINGSTEN RD STE 3100
GLENVIEW IL
60026-1339
US

V. Phone/Fax

Practice location:
  • Phone: 847-866-7846
  • Fax: 866-954-5787
Mailing address:
  • Phone: 847-866-7846
  • Fax: 866-954-5787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036098303
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number036098303
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: