Provider Demographics
NPI:1053677005
Name:MCILWAIN, CARRIE ALLISON (MD)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:ALLISON
Last Name:MCILWAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 W 95TH ST STE 330
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2416
Mailing Address - Country:US
Mailing Address - Phone:708-422-3242
Mailing Address - Fax:708-422-3243
Practice Address - Street 1:6700 W 95TH ST STE 330
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2416
Practice Address - Country:US
Practice Address - Phone:708-422-3242
Practice Address - Fax:708-422-3243
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-04
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036150166207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Single Specialty