Provider Demographics
NPI:1568183226
Name:CARMICHAEL, CAILEB (PA)
Entity type:Individual
Prefix:
First Name:CAILEB
Middle Name:
Last Name:CARMICHAEL
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Gender:
Credentials:PA
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Other - First Name:
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Mailing Address - Street 1:2650 RIDGE AVE STE 1223
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1700
Mailing Address - Country:US
Mailing Address - Phone:847-982-3175
Mailing Address - Fax:847-335-3158
Practice Address - Street 1:5215 N CALIFORNIA AVE STE F804
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-7014
Practice Address - Country:US
Practice Address - Phone:773-907-7750
Practice Address - Fax:773-907-7760
Is Sole Proprietor?:No
Enumeration Date:2022-09-09
Last Update Date:2025-04-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL085-010083363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant