Healthcare Provider Details

I. General information

NPI: 1033478342
Provider Name (Legal Business Name): CHELSIE RENAE CARLTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2012
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 E LAKE ST STE 202
HANOVER PARK IL
60133-7152
US

IV. Provider business mailing address

1 ERIE CT STE 6160
OAK PARK IL
60302-2510
US

V. Phone/Fax

Practice location:
  • Phone: 844-599-3700
  • Fax:
Mailing address:
  • Phone: 708-763-1490
  • Fax: 708-763-7232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036.157835
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: