MEDICARE: DR. CAROLYN PAYNE 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	208000000X	Pediatrics Physician	036154724	IL
2	390200000X	Student in an Organized Health Care Education/Training Program	BP10052876	TX
3	207R00000X	Internal Medicine Physician	S2145	TX
4	207R00000X	Internal Medicine Physician	036154724	IL

General Provider Information

NPI Number	:	1508247602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROLYN PAYNE M.D.

Provider Business Mailing Address
First Line	:	180 HARVESTER DR STE 110
Second Line	:
City	:	BURR RIDGE
State	:	IL
Zip	:	60527-4503
Country	:	US
Telephone Number	:	773-702-1150
Fax Number	:

Provider Business Practice Location Address
First Line	:	5841 S MARYLAND AVE # 6098
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-1443
Country	:	US
Telephone Number	:	773-753-0552
Fax Number	:

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

Provider Enumeration Date	:	06/15/2015
Last Update Date	:	06/02/2026

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