Healthcare Provider Details

I. General information

NPI: 1871084624
Provider Name (Legal Business Name): CAROLYN ELAINE AUFFENBERG, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2018
Last Update Date: 05/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 REVERE DR STE 100
NORTHBROOK IL
60062-1590
US

IV. Provider business mailing address

60 REVERE DR STE 100
NORTHBROOK IL
60062-1590
US

V. Phone/Fax

Practice location:
  • Phone: 224-306-1879
  • Fax: 224-205-3757
Mailing address:
  • Phone: 224-306-1879
  • Fax: 224-205-3757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: CAROLYN E AUFFENBERG
Title or Position: MD
Credential: MD
Phone: 243-061-8792