Fairbanks, LLC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

FAIRBANKS, LLC

Practice address

3880 Salem Lake Dr Ste a
Long Grove, IL 60047-5292

Phone

(312) 321-1225

NPI assigned

Feb 7, 2018

Organization subpart

No

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

Authorized official

Name

Lisa Carnes

Title

Principal

Phone

(312) 450-6382

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1517961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1517961600000",
    "number": "1619476405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3880 SALEM LAKE DR STE A",
            "city": "LONG GROVE",
            "state": "IL",
            "postal_code": "600475292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3880 SALEM LAKE DR STE A",
            "city": "LONG GROVE",
            "state": "IL",
            "postal_code": "600475292",
            "telephone_number": "312-321-1225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRBANKS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-07",
        "last_updated": "2018-02-07",
        "status": "A",
        "authorized_official_last_name": "CARNES",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "PRINCIPAL",
        "authorized_official_telephone_number": "312-450-6382"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "208449",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dynamix Rehabilitation Services, Inc.
• Margarita Ekelman, MBA, RDN, LDN
• Kirk Wayne Erickson, PSY.D.
• Heidy Hwang Evans
• Shakeema Alexandra Facey, ARNP
• Mazin Fattouhi, M.D.
• Elizabeth J Fazio, PSYD
• Carolyn Federman, MD
• Felice Block Ma LCPC
• Mary Susan Fidale, LCPC, RNC

• Specialist in Long Grove, IL
• Providers in Long Grove, IL by specialty
• Specialist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2018; 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.