Provider Demographics
NPI:1285830166
Name:CARQUEVILLE, JORDAN CLAIRE (MD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:CLAIRE
Last Name:CARQUEVILLE
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 1:920 N YORK RD STE 100
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3515
Mailing Address - Country:US
Mailing Address - Phone:312-319-1978
Mailing Address - Fax:312-262-7791
Practice Address - Street 1:737 N MICHIGAN AVE STE 720
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-6661
Practice Address - Country:US
Practice Address - Phone:312-319-1978
Practice Address - Fax:312-262-7791
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.130085207ND0101X, 207ND0900X, 207NS0135X, 207N00000X
CAA116000207N00000X
IL125053046390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program