MEDICARE: DR. CAROL ANN MEYNEN 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	207VG0400X	Gynecology Physician	036060419	IL

General Provider Information

NPI Number	:	1821073339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROL ANN MEYNEN M.D.

Provider Business Mailing Address
First Line	:	333 ANJOU DR
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-2208
Country	:	US
Telephone Number	:	847-715-9702
Fax Number	:

Provider Business Practice Location Address
First Line	:	310 HAPP RD
Second Line	:	SUITE 207
City	:	NORTHFIELD
State	:	IL
Zip	:	60093-3455
Country	:	US
Telephone Number	:	847-446-4370
Fax Number	:	847-784-5201

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

Provider Enumeration Date	:	12/07/2005
Last Update Date	:	07/31/2010

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