Provider Demographics
NPI:1316932668
Name:CARR, THOMAS CARL (DPM)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:CARL
Last Name:CARR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:467 W ERIE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-5704
Mailing Address - Country:US
Mailing Address - Phone:312-337-9900
Mailing Address - Fax:312-337-9902
Practice Address - Street 1:467 W ERIE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-5704
Practice Address - Country:US
Practice Address - Phone:312-337-9900
Practice Address - Fax:312-337-9902
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004401213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL60010789OtherBCBS
IL016004401Medicaid
ILL39124Medicare PIN
IL016004401Medicaid
IL0581740001Medicare NSC