Provider Demographics
NPI:1811988397
Name:THARP, CAROL KAY (MD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:KAY
Last Name:THARP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:840 GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-1864
Mailing Address - Country:US
Mailing Address - Phone:847-446-7996
Mailing Address - Fax:847-446-7926
Practice Address - Street 1:840 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:IL
Practice Address - Zip Code:60093-1864
Practice Address - Country:US
Practice Address - Phone:847-446-7996
Practice Address - Fax:847-446-7926
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D12573Medicare UPIN
IL471200Medicare PIN