Provider Demographics
NPI:1538261680
Name:CARPENTER, CARLA A (DO)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:A
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:C
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:545 PLAINFIELD RD STE C
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-7601
Mailing Address - Country:US
Mailing Address - Phone:630-654-2229
Mailing Address - Fax:630-655-3270
Practice Address - Street 1:545 PLAINFIELD RD STE C
Practice Address - Street 2:
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-7601
Practice Address - Country:US
Practice Address - Phone:630-654-2229
Practice Address - Fax:630-655-3270
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-083442207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL002223846OtherBC/BS
596640Medicare ID - Type Unspecified
F00043Medicare UPIN