Healthcare Provider Details

I. General information

NPI: 1962402065
Provider Name (Legal Business Name): CARMEN M WOODS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 10/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 GREENLEAF AVE STE A
PARK CITY IL
60085-5701
US

IV. Provider business mailing address

351 GREENLEAF AVE SUITE A
PARK CITY IL
60085-5701
US

V. Phone/Fax

Practice location:
  • Phone: 847-244-4100
  • Fax: 847-244-4494
Mailing address:
  • Phone: 847-244-4100
  • Fax: 847-244-4494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: