Provider Demographics
NPI:1033190814
Name:ARENTZEN, CARL E (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:E
Last Name:ARENTZEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19684
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62794-9684
Mailing Address - Country:US
Mailing Address - Phone:217-545-7600
Mailing Address - Fax:217-545-2552
Practice Address - Street 1:619 E MASON ST
Practice Address - Street 2:SUITE 3P25
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62701-1034
Practice Address - Country:US
Practice Address - Phone:217-545-7600
Practice Address - Fax:217-545-2552
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036072083208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036072083Medicaid
C46074Medicare UPIN
ILK09156Medicare PIN
IL256510Medicare PIN