Provider Demographics
NPI:1407129364
Name:CARLTON A. WEST, MD SC
Entity Type:Organization
Organization Name:CARLTON A. WEST, MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLTON
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-225-2055
Mailing Address - Street 1:443 E 31ST ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-4051
Mailing Address - Country:US
Mailing Address - Phone:312-225-2055
Mailing Address - Fax:312-225-7437
Practice Address - Street 1:443 E 31ST ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-4051
Practice Address - Country:US
Practice Address - Phone:312-225-2055
Practice Address - Fax:312-225-7437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty