Provider Demographics
NPI:1497574883
Name:SYPH, CARLETON BRUCE II
Entity type:Individual
Prefix:MR
First Name:CARLETON
Middle Name:BRUCE
Last Name:SYPH
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:848 DODGE AVE # 426
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-1506
Mailing Address - Country:US
Mailing Address - Phone:224-725-0765
Mailing Address - Fax:
Practice Address - Street 1:5820 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60636-1527
Practice Address - Country:US
Practice Address - Phone:224-725-0765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide