1609039734 NPI number — CARMEN AMELIA TAYPE-ROBERTS M.D., PH.D.

Table of content: CARMEN AMELIA TAYPE-ROBERTS M.D., PH.D. (NPI 1609039734)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609039734 NPI number — CARMEN AMELIA TAYPE-ROBERTS M.D., PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAYPE-ROBERTS
Provider First Name:
CARMEN
Provider Middle Name:
AMELIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D., PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TAYPE PEREZ DE ROBERTS
Provider Other First Name:
CARMEN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1609039734
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
251 E HURON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60611-3055
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-296-2000
Provider Business Mailing Address Fax Number:
312-695-5873

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
251 E HURON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60611-2908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-296-2000
Provider Business Practice Location Address Fax Number:
312-695-5873
Provider Enumeration Date:
07/09/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  40537 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: A114901 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RS0012X , with the licence number: 036.156003 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 405378 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".