Provider Demographics
NPI:1497790505
Name:DRS BEAMER CARLON CRAIGEN SC
Entity Type:Organization
Organization Name:DRS BEAMER CARLON CRAIGEN SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:K
Authorized Official - Last Name:BEAMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-628-0600
Mailing Address - Street 1:1011 W LAKE ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1148
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:SUITE 300
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X, 207R00000X, 207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1634566OtherBCBS PROVIDER ID
ILDC8910OtherRAILROAD MEDICARE
IL209994Medicare PIN