Provider Demographics
NPI:1609928415
Name:CARSE, SHIREESHA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIREESHA
Middle Name:
Last Name:CARSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 PENTWATER DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-9331
Mailing Address - Country:US
Mailing Address - Phone:415-845-0015
Mailing Address - Fax:
Practice Address - Street 1:34 PENTWATER DR
Practice Address - Street 2:
Practice Address - City:SOUTH BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-9331
Practice Address - Country:US
Practice Address - Phone:415-845-0015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA707182085R0202X
IL0360977392085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A707180Medicaid
H23843Medicare UPIN
CA00A707180Medicaid