Provider Demographics
NPI:1851377048
Name:ROBINSON, CARMELITA ROWENA (MD)
Entity Type:Individual
Prefix:DR
First Name:CARMELITA
Middle Name:ROWENA
Last Name:ROBINSON
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:PO BOX 805192
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60680-4113
Mailing Address - Country:US
Mailing Address - Phone:773-221-1400
Mailing Address - Fax:773-221-3258
Practice Address - Street 1:8741 S GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-7061
Practice Address - Country:US
Practice Address - Phone:773-221-1400
Practice Address - Fax:773-221-3258
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL350900Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID
ILF20459Medicare UPIN