Healthcare Provider Details

I. General information

NPI: 1821074121
Provider Name (Legal Business Name): CAROLYN ANN WINNINGHAM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 07/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 GREEN BAY RD
NORTH CHICAGO IL
60064-3048
US

IV. Provider business mailing address

5 N DIXON DR
BATAVIA IL
60510-7644
US

V. Phone/Fax

Practice location:
  • Phone: 847-688-6755
  • Fax:
Mailing address:
  • Phone: 303-587-1478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number44779-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: