Imelda S Carlos, MD FAAP

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

036061984 Issued in IL

Practice address

511 Thornhill Dr
Suite F
Carol Stream, IL 60188

Phone

(630) 462-7330

Fax

(630) 462-7385

NPI assigned

Oct 12, 2006

Last updated

Oct 26, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1351209600000",
    "number": "1699864124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "511 THORNHILL DR",
            "address_2": "SUITE F",
            "city": "CAROL STREAM",
            "state": "IL",
            "postal_code": "60188",
            "telephone_number": "630-462-7330",
            "fax_number": "630-462-7385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "511 THORNHILL DR",
            "address_2": "SUITE F",
            "city": "CAROL STREAM",
            "state": "IL",
            "postal_code": "60188",
            "telephone_number": "630-462-7330",
            "fax_number": "630-462-7385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLOS",
        "first_name": "IMELDA",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "MD FAAP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-12",
        "last_updated": "2012-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036061984",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036061984",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Manuel D Calvillo Jr., ATC
• Canvas Behavior Consulting, LLC
• Cardia Counseling Center, Inc.
• Caremaxdme LLC
• Caring Heavenly Hands (ComForcare Senior Service-Dupage)
• Carol Stream Dental Associates
• Carol Stream Fire Protection District
• Carol Stream Medical PLLC
• Carol Stream Pharmacy P.C
• Carol Stream Vision Center

• Pediatrics Physician in Carol Stream, IL
• Providers in Carol Stream, IL by specialty
• Pediatrics Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2012; 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.