Provider Demographics
NPI:1801076609
Name:NICHOLAS C CARO MD, LLC
Entity type:Organization
Organization Name:NICHOLAS C CARO MD, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:CARO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-685-5606
Mailing Address - Street 1:4151 W PETERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-6002
Mailing Address - Country:US
Mailing Address - Phone:773-685-5606
Mailing Address - Fax:773-685-6559
Practice Address - Street 1:4151 W PETERSON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-6002
Practice Address - Country:US
Practice Address - Phone:773-685-5606
Practice Address - Fax:773-685-6559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1617766OtherBLUE CROSS BLUE SHIELD
IL1617766OtherBLUE CROSS BLUE SHIELD
IL764450Medicare PIN