Basic Information
| Provider Information | |||||||||
| NPI: | 1639545882 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | KAREFIRST INDIANA PC | ||||||||
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| OtherOrganizationName: | KAREFIRST INDIANA, P.C. | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4711 GOLF RD | ||||||||
| Address2: | STE 1250 | ||||||||
| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600761224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8472356130 | ||||||||
| FaxNumber: | 8472356135 | ||||||||
| Practice Location | |||||||||
| Address1: | 4711 GOLF RD | ||||||||
| Address2: | STE 1250 | ||||||||
| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600761224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8472356130 | ||||||||
| FaxNumber: | 8472356135 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2015 | ||||||||
| LastUpdateDate: | 08/14/2015 | ||||||||
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| AuthorizedOfficialLastName: | WILSON | ||||||||
| AuthorizedOfficialFirstName: | KIMBERLY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7735521243 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | RN, APN, MSN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.