Provider Demographics
NPI:1922294842
Name:CSR PRIMARY CARE,LLC
Entity Type:Organization
Organization Name:CSR PRIMARY CARE,LLC
Other - Org Name:CSR PRIMARY CARE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:LANG CARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-316-8700
Mailing Address - Street 1:800 AUSTIN ST
Mailing Address - Street 2:EAST TOWER #166
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-3439
Mailing Address - Country:US
Mailing Address - Phone:847-316-2100
Mailing Address - Fax:
Practice Address - Street 1:800 AUSTIN ST
Practice Address - Street 2:EAST TOWER #166
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3439
Practice Address - Country:US
Practice Address - Phone:847-316-2100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21623388OtherBLUE SHIELD OF ILLINOIS
IL579340OtherMEDICARE