MEDICARE: FABIAN CARBONELL MD

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	2084P0800X	Psychiatry Physician	036098028	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295705119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FABIAN CARBONELL MD

Provider Business Mailing Address
First Line	:	2845 N SHERIDAN RD STE 708
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-7227
Country	:	US
Telephone Number	:	773-649-4261
Fax Number	:	872-243-2843

Provider Business Practice Location Address
First Line	:	2845 N SHERIDAN RD STE 708
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-7227
Country	:	US
Telephone Number	:	773-649-4261
Fax Number	:	872-243-2843

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

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	11/17/2023

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Directions to “ FABIAN CARBONELL MD” Practice Location

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