MEDICARE: DR. MICHAEL R CARR M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0202X	Pediatric Cardiology Physician	0101102544	VA
2	2080P0202X	Pediatric Cardiology Physician	036130481	IL

General Provider Information

NPI Number	:	1285770925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL R CARR M.D.

Provider Business Mailing Address
First Line	:	225 EAST CHICAGO AVENUE
Second Line	:	BOX 21 LURIE CHILDREN'S HOSPITAL,
City	:	CHICAGO
State	:	IL
Zip	:	60611
Country	:	US
Telephone Number	:	312-227-4100
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 EAST CHICAGO AVENUE
Second Line	:	BOX 21 LURIE CHILDREN'S HOSPITAL,
City	:	CHICAGO
State	:	IL
Zip	:	60611
Country	:	US
Telephone Number	:	312-227-4100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	07/05/2012

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