Provider Demographics
NPI:1689709933
Name:CARLOS, ILONA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:ILONA
Middle Name:MARIE
Last Name:CARLOS
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 1:500 W SUPERIOR ST UNIT 1708
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-8145
Mailing Address - Country:US
Mailing Address - Phone:312-718-0263
Mailing Address - Fax:
Practice Address - Street 1:9054 COLUMBIA AVE STE B
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2905
Practice Address - Country:US
Practice Address - Phone:219-703-2426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036101641207V00000X
IN01082896A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
01630320OtherBCBS
501046OtherADVOCATE
IL036101641Medicaid
01630320OtherBCBS
IL036101641Medicaid