MEDICARE: JOSEPH NEMOURS CARRE 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	2085R0202X	Diagnostic Radiology Physician	36-065253	IL
2	2085R0204X	Vascular & Interventional Radiology Physician	36-065253	IL
3	2085U0001X	Diagnostic Ultrasound Physician	36-065253	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	630001349	OTHER	IL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	01621175	OTHER	IL	BC/BS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821090622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH NEMOURS CARRE MD

Provider Business Mailing Address
First Line	:	6415 N CALIFORNIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-5208
Country	:	US
Telephone Number	:	773-262-5400
Fax Number	:	773-743-0136

Provider Business Practice Location Address
First Line	:	6415 N CALIFORNIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-5208
Country	:	US
Telephone Number	:	773-262-5400
Fax Number	:	773-743-0136

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	03/27/2013

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Directions to “ JOSEPH NEMOURS CARRE MD” Practice Location

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