Provider Demographics
NPI:1750375572
Name:GOLDEN-BRENNER, CARRIE E (MD)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:E
Last Name:GOLDEN-BRENNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:E
Other - Last Name:GOLDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:800 AUSTIN
Mailing Address - Street 2:SUITE 151
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202
Mailing Address - Country:US
Mailing Address - Phone:847-328-2300
Mailing Address - Fax:847-492-1988
Practice Address - Street 1:800 AUSTIN
Practice Address - Street 2:SUITE 151
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202
Practice Address - Country:US
Practice Address - Phone:847-328-2300
Practice Address - Fax:847-492-1988
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-69488207W00000X
IL036.069488207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036069488Medicaid
IL01623637OtherBCBS NUMBER
IL01623637OtherBLUE SHIELD NUMBER
IL036069488Medicaid
ILC38594Medicare UPIN