1336224658 NPI number — CAROL AVI HANDELSMAN MD

Table of content: CAROL AVI HANDELSMAN MD (NPI 1336224658)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336224658 NPI number — CAROL AVI HANDELSMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANDELSMAN
Provider First Name:
CAROL
Provider Middle Name:
AVI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336224658
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 88487
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:
60680-1487
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-791-2000
Provider Business Mailing Address Fax Number:
312-791-2076

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5454 HOHMAN AVENUE
Provider Second Line Business Practice Location Address:
SAINT MARGARET MERCY HEALTHCARE CENTERS
Provider Business Practice Location Address City Name:
HAMMOND
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-891-9305
Provider Business Practice Location Address Fax Number:
219-933-2597
Provider Enumeration Date:
10/26/2006

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: 207ZP0102X , with the licence number:  036066741 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0102X , with the licence number: MD196457 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207ZP0102X , with the licence number: 01057575A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 036066741 1 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".