Provider Demographics
NPI:1285670273
Name:CARLON, MICHELE FRANCES (MD)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:FRANCES
Last Name:CARLON
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 1:1011 W. LAKE ST
Mailing Address - Street 2:STE 300
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1138
Mailing Address - Country:US
Mailing Address - Phone:708-628-0600
Mailing Address - Fax:708-628-0608
Practice Address - Street 1:1011 LAKE ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1148
Practice Address - Country:US
Practice Address - Phone:708-628-0600
Practice Address - Fax:708-628-0608
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1634566OtherBCBS PROVIDER ID
ILP00196558OtherRAILROAD MEDICARE
IL1634566OtherBCBS PROVIDER ID
ILP00196558OtherRAILROAD MEDICARE
ILF45684Medicare UPIN