Provider Demographics
NPI:1265446710
Name:CARRYON, PAUL (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:CARRYON
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 1:2800 S VERNON
Mailing Address - Street 2:1ST FLOOR FLORSHEIM MEDICAL BLDG
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616
Mailing Address - Country:US
Mailing Address - Phone:312-842-1900
Mailing Address - Fax:312-842-4387
Practice Address - Street 1:2800 S VERNON
Practice Address - Street 2:1ST FLOOR FLORSHEIM MEDICAL BLDG
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616
Practice Address - Country:US
Practice Address - Phone:312-842-1900
Practice Address - Fax:312-842-4387
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036050421207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0031601723OtherBLUE CROSS SHIELD
IL036050421Medicaid
IL0031601723OtherBLUE CROSS SHIELD
IL693091Medicare ID - Type Unspecified