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General NPI Number Information
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NPI Number | 1578767935
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Entity Type | Organization
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Legal Business Name | FABIAN CARBONELL MD SC
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Dates
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Enumeration Date | 06/12/2007
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Last Update Date | 11/17/2023
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Provider Practice Location Address
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Address Line | 331 W SURF ST STE 708
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City | CHICAGO
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State | IL
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Zip | 60657-7227
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Country | US
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Telephone | 773-649-4261
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Fax | 872-243-2843
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Provider Business Mailing Address
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Address Line | 331 W SURF ST STE 708
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City | CHICAGO
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State | IL
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Zip | 60657-7227
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Country | US
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Telephone | 773-649-4261
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | FABIAN CARBONELL
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Credential | MD
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Telephone | 773-649-4261
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036098028
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License Number State | IL
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