Provider Demographics
NPI:1851388995
Name:NAWARA, CAROLINE (MD)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:NAWARA
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 1:401 S STATE ST
Mailing Address - Street 2:SUITE 430
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-1229
Mailing Address - Country:US
Mailing Address - Phone:312-789-4677
Mailing Address - Fax:312-789-4676
Practice Address - Street 1:401 S STATE ST
Practice Address - Street 2:SUITE 430
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-1229
Practice Address - Country:US
Practice Address - Phone:312-789-4677
Practice Address - Fax:312-789-4676
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036081137207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036081137Medicaid
ILF14229Medicare UPIN
IL210343Medicare ID - Type Unspecified