Glenn F Carlson Jr., MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036.073913 Issued in IL

Practice address

717 N Waiola Ave
La Grange Park, IL 60526-1451

Phone

(610) 563-7515

NPI assigned

Aug 7, 2025

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1754524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754524800000",
    "number": "1225913429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "717 N WAIOLA AVE",
            "city": "LA GRANGE PARK",
            "state": "IL",
            "postal_code": "605261451",
            "telephone_number": "610-563-7515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "717 N WAIOLA AVE",
            "city": "LA GRANGE PARK",
            "state": "IL",
            "postal_code": "605261451",
            "telephone_number": "610-563-7515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLSON",
        "first_name": "GLENN",
        "middle_name": "F",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-08-07",
        "last_updated": "2025-08-07",
        "certification_date": "2025-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036.073913",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael B Byars Sr.
• Gina Margaret Canerday
• Karen Anne Cannon-Janettas
• Colton Cannon
• Kelly Caraher
• Sophia Catherine Caruso
• Mary Elizabeth Castronova
• Kathryn Nicole Cerven
• Eumi Ann Chang, D.C.
• Colleen Clarke

• Internal Medicine Physician in La Grange Park, IL
• Providers in La Grange Park, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.