Healthcare Provider Details

I. General information

NPI: 1104800648
Provider Name (Legal Business Name): CAROLMARK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 03/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18118 1/2 MARTIN AVE 1EE
HOMEWOOD IL
60430-2120
US

IV. Provider business mailing address

18118 1/2 MARTIN AVE 1EE
HOMEWOOD IL
60430-2120
US

V. Phone/Fax

Practice location:
  • Phone: 708-922-0588
  • Fax: 708-922-0599
Mailing address:
  • Phone: 708-922-0588
  • Fax: 708-922-0599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number203000542
License Number StateIL

VIII. Authorized Official

Name: MR. MARK ARNOLD ELIAS
Title or Position: PRESIDENT
Credential: RCP
Phone: 708-922-0588