Healthcare Provider Details

I. General information

NPI: 1013948470
Provider Name (Legal Business Name): KEVIN C CARNEY X M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 SHAFER CT STE 600
ROSEMONT IL
60018-4988
US

IV. Provider business mailing address

5835 W WILSON AVE
CHICAGO IL
60630-3323
US

V. Phone/Fax

Practice location:
  • Phone: 847-983-8257
  • Fax:
Mailing address:
  • Phone: 773-706-3821
  • Fax: 773-685-3734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036080283
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: