Provider Demographics
NPI:1851072177
Name:CARSON, ESMERALDA MERCEDES (RSS)
Entity Type:Individual
Prefix:MRS
First Name:ESMERALDA
Middle Name:MERCEDES
Last Name:CARSON
Suffix:
Gender:F
Credentials:RSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10531 S WHIPPLE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60655-2034
Mailing Address - Country:US
Mailing Address - Phone:312-662-2226
Mailing Address - Fax:
Practice Address - Street 1:11560 S KEDZIE AVE STE 200
Practice Address - Street 2:
Practice Address - City:MERRIONETTE PARK
Practice Address - State:IL
Practice Address - Zip Code:60803-4517
Practice Address - Country:US
Practice Address - Phone:708-974-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist