Provider Demographics
NPI:1265424725
Name:AUGUST, CAREY Z (MD)
Entity type:Individual
Prefix:
First Name:CAREY
Middle Name:Z
Last Name:AUGUST
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 1:1775 DEMPSTER ST
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1143
Mailing Address - Country:US
Mailing Address - Phone:847-723-2210
Mailing Address - Fax:773-296-7444
Practice Address - Street 1:520 E 22ND ST
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-6110
Practice Address - Country:US
Practice Address - Phone:630-874-2542
Practice Address - Fax:630-874-2642
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036066937207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD16109Medicare UPIN