Provider Demographics
NPI:1316002603
Name:BERKES, CAROLYN ANN (MD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ANN
Last Name:BERKES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:CAROLYN
Other - Middle Name:ANN
Other - Last Name:BERKES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
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:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036082873208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036082873Medicaid
ILL73125Medicare UPIN
L73125Medicare UPIN