Healthcare Provider Details

I. General information

NPI: 1730672619
Provider Name (Legal Business Name): CAROLINE BRANDER LORING MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. CAROLINE BRANDER

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 04/19/2022
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 W 95TH ST
OAK LAWN IL
60453-2600
US

IV. Provider business mailing address

4440 W 95TH ST
OAK LAWN IL
60453-2600
US

V. Phone/Fax

Practice location:
  • Phone: 708-684-3296
  • Fax:
Mailing address:
  • Phone: 708-684-3296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125072316
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: