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NPI Code Detail

MEDICARE: DR. GORDON E. CARR M.D.

MEDICARE:  DR. GORDON E. 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
1207RP1001XPulmonary Disease Physician036120415IL
2207RC0200XCritical Care Medicine (Internal Medicine) Physician036120415IL

General Provider Information

NPI Number : 1407030729
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GORDON E. CARR M.D.
Provider Business Mailing Address
First Line : 5841 S MARYLAND AVE
Second Line : MC 6076
City : CHICAGO
State : IL
Zip : 60637-1447
Country : US
Telephone Number : 773-702-9660
Fax Number :
Provider Business Practice Location Address
First Line : 5841 S MARYLAND AVE
Second Line : MC 6076
City : CHICAGO
State : IL
Zip : 60637-1447
Country : US
Telephone Number : 773-702-9660
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2007
Last Update Date : 01/25/2011

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