Provider Demographics
NPI:1245395599
Name:DANZIGER, CAROLYN REGINA (MD)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:REGINA
Last Name:DANZIGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:REGINA
Other - Last Name:GAWRYSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3070 SOUTH WOLF ROAD
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154
Mailing Address - Country:US
Mailing Address - Phone:708-562-6502
Mailing Address - Fax:708-562-6630
Practice Address - Street 1:3070 SOUTH WOLF ROAD
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154
Practice Address - Country:US
Practice Address - Phone:708-562-6502
Practice Address - Fax:708-562-6630
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
L73124Medicare UPIN