Provider Demographics
NPI:1699864124
Name:CARLOS, IMELDA S (MD FAAP)
Entity type:Individual
Prefix:DR
First Name:IMELDA
Middle Name:S
Last Name:CARLOS
Suffix:
Gender:F
Credentials:MD FAAP
Other - Prefix:
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Mailing Address - Street 1:511 THORNHILL DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188
Mailing Address - Country:US
Mailing Address - Phone:630-462-7330
Mailing Address - Fax:630-462-7385
Practice Address - Street 1:511 THORNHILL DR
Practice Address - Street 2:SUITE F
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188
Practice Address - Country:US
Practice Address - Phone:630-462-7330
Practice Address - Fax:630-462-7385
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036061984208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036061984Medicaid