Provider Demographics
NPI:1699978379
Name:CAROLINE NAWARA MD, S.C.
Entity type:Organization
Organization Name:CAROLINE NAWARA MD, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:NAWARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-789-4677
Mailing Address - Street 1:401 S STATE ST
Mailing Address - Street 2:SUITE 430
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-1229
Mailing Address - Country:US
Mailing Address - Phone:312-789-4677
Mailing Address - Fax:312-789-4676
Practice Address - Street 1:401 S STATE ST
Practice Address - Street 2:SUITE 430
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-1229
Practice Address - Country:US
Practice Address - Phone:312-789-4677
Practice Address - Fax:312-789-4676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036081137207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036081137Medicaid
IL210343Medicare ID - Type Unspecified
IL036081137Medicaid