MEDICARE: CAROLYNN PRICE 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	208000000X	Pediatrics Physician	036.142920	IL
2	390200000X	Student in an Organized Health Care Education/Training Program		IL

General Provider Information

NPI Number	:	1629495023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYNN PRICE MD

Provider Business Mailing Address
First Line	:	225 E CHICAGO AVENUE
Second Line	:	BOX 18
City	:	CHICAGO
State	:	IL
Zip	:	60611
Country	:	US
Telephone Number	:	781-227-4000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2251 N BURLING ST # 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-3711
Country	:	US
Telephone Number	:	781-249-1422
Fax Number	:

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

Provider Enumeration Date	:	03/24/2014
Last Update Date	:	06/30/2017

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Directions to “ CAROLYNN PRICE MD” Practice Location

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