Healthcare Provider Details

I. General information

NPI: 1659395119
Provider Name (Legal Business Name): CARY ROBERT TEMPLIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 11/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 ESSINGTON RD
JOLIET IL
60435-8427
US

IV. Provider business mailing address

550 W OGDEN AVE
HINSDALE IL
60521-3186
US

V. Phone/Fax

Practice location:
  • Phone: 815-744-4551
  • Fax: 815-744-4756
Mailing address:
  • Phone: 630-323-6116
  • Fax: 630-323-6169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036113890
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: