Provider Demographics
NPI:1609039734
Name:TAYPE-ROBERTS, CARMEN AMELIA (MD, PHD)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:AMELIA
Last Name:TAYPE-ROBERTS
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:
Other - Last Name:TAYPE PEREZ DE ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:251 E HURON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3055
Mailing Address - Country:US
Mailing Address - Phone:312-296-2000
Mailing Address - Fax:312-695-5873
Practice Address - Street 1:251 E HURON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2908
Practice Address - Country:US
Practice Address - Phone:312-296-2000
Practice Address - Fax:312-695-5873
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC40537207RP1001X
CAA114901207RP1001X
IL036.156003207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC405378Medicaid