Provider Demographics
NPI:1477538916
Name:SCARIMBOLO, CARMEN J (MD)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:J
Last Name:SCARIMBOLO
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 1:2801 LAKESIDE DR STE 209
Mailing Address - Street 2:
Mailing Address - City:BANNOCKBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60015-1271
Mailing Address - Country:US
Mailing Address - Phone:847-562-1410
Mailing Address - Fax:847-562-0830
Practice Address - Street 1:350 S NORTHWEST HWY STE 112
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4262
Practice Address - Country:US
Practice Address - Phone:847-825-8108
Practice Address - Fax:847-825-1774
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036075279207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL202300002Medicare PIN
ILL007237OtherCHAMPUS
IL0360752791Medicaid
IL603590Medicare PIN
ILE18780Medicare UPIN
IL202301002Medicare PIN