Healthcare Provider Details

I. General information

NPI: 1003296849
Provider Name (Legal Business Name): CARLY STOKAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2015
Last Update Date: 12/10/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3722 W TOUHY AVE SUITE 101
SKOKIE IL
60067
US

IV. Provider business mailing address

1460 N HALSTED ST STE 402
CHICAGO IL
60642-2607
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-2860
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036145696
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125067293
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: