Provider Demographics
NPI:1760471189
Name:JAPZON REBANDEL, CAROLINA G (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLINA
Middle Name:G
Last Name:JAPZON REBANDEL
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 1:2202 N LINCOLN AVE
Mailing Address - Street 2:STE 4
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-7170
Mailing Address - Country:US
Mailing Address - Phone:773-871-3444
Mailing Address - Fax:773-871-7906
Practice Address - Street 1:2202 N LINCOLN AVE
Practice Address - Street 2:STE 4
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-7170
Practice Address - Country:US
Practice Address - Phone:773-871-3444
Practice Address - Fax:773-871-7906
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
467620Medicare ID - Type Unspecified
D12478Medicare UPIN