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1750382974 NPI number — ANDREA GALE CARLSON MD

NPI Number: 1750382974
Health Care Provider/Practitioner: ANDREA GALE CARLSON MD

Information about “1750382974” NPI (ANDREA GALE CARLSON MD) exists in 1750382974 in HTML format HTML  |  1750382974 in plain Text format TXT  |  1750382974 in PDF (Portable Document Format) PDF  |  1750382974 in an XML format XML  formats.

NPI Number : 1750382974 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1750382974",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CARLSON",
    "FirstName": "ANDREA",
    "MiddleName": "GALE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 88495",
    "SecondLineMailingAddress": "DEPT A",
    "MailingAddressCityName": "CHICAGO",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60680-1495",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "630-734-0200",
    "MailingAddressFaxNumber": "630-734-1560",
    "FirstLinePracticeLocationAddress": "3815 HIGHLAND AVE",
    "SecondLinePracticeLocationAddress": "ADVOCATE GOOD SAMARITAN HOSPITAL",
    "PracticeLocationAddressCityName": "DOWNERS GROVE",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60515-1500",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "630-275-5900",
    "PracticeLocationAddressFaxNumber": "630-734-1560",
    "EnumerationDate": "08/10/2005",
    "LastUpdateDate": "12/21/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207P00000X",
        "TaxonomyName": "Emergency Medicine Physician",
        "LicenseNumber": "036-100002",
        "LicenseNumberStateCode": "IL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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