=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750371340
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELE C CARNEY MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2005
-----------------------------------------------------
Last Update Date | 05/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 608 S WASHINGTON ST STE 204
-----------------------------------------------------
City | NAPERVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60540-6675
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-348-3080
-----------------------------------------------------
Fax | 630-646-5648
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 RANDALL RD
-----------------------------------------------------
City | GENEVA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60134-4200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-653-4240
-----------------------------------------------------
Fax | 630-938-9190
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 036103394
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------