Basic Information
Provider Information
NPI: 1326543893
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CARPENTER
FirstName: ARIEL
MiddleName: ESTHER
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 776351
Address2:  
City: CHICAGO
State: IL
PostalCode: 606776351
CountryCode: US
TelephoneNumber: 5025889490
FaxNumber: 5022725339
Practice Location
Address1: 7926 PRESTON HWY STE 106
Address2:  
City: LOUISVILLE
State: KY
PostalCode: 40219
CountryCode: US
TelephoneNumber: 5029644357
FaxNumber: 5029665948
Other Information
ProviderEnumerationDate: 03/27/2018
LastUpdateDate: 01/26/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/26/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000XR4668KYN Allopathic & Osteopathic PhysiciansPediatrics 
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
207R00000XR4668KYY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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