NPIMap

Organization Active NPI

Kim M Carnazzola MD SC

  • Family Medicine Physician
  • Libertyville, IL
National Provider Identifier
1902104037
Registry record updated Apr 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036085955 Issued in IL
Legal business name
KIM M CARNAZZOLA MD SC
Practice address
1860 W Winchester Rd
Suite 109
Libertyville, IL 60048-5351
Phone
(847) 996-0607
Fax
(847) 996-0608
NPI assigned
Mar 15, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2012

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

Authorized official

Name
Dr. Kim M Carnazzola, MD
Title
President
Phone
(847) 996-0607

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 036085955 IL Primary

Addresses

Primary practice location

1860 W Winchester Rd
Suite 109
Libertyville, IL 60048-5351

Mailing address

1860 W Winchester Rd
Suite 109
Libertyville, IL 60048-5351
Phone (847) 996-0607

National Provider Directory

National Provider Directory

Locations

1860 W Winchester Rd
Ste 109
Libertyville, IL 60048
Phone (847) 996-0607

NPI Registry JSON

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

{
    "created_epoch": "1300147200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334793600000",
    "number": "1902104037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1860 W WINCHESTER RD",
            "address_2": "SUITE 109",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600485351",
            "telephone_number": "847-996-0607",
            "fax_number": "847-996-0608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1860 W WINCHESTER RD",
            "address_2": "SUITE 109",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600485351",
            "telephone_number": "847-996-0607",
            "fax_number": "847-996-0608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIM M CARNAZZOLA MD SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-15",
        "last_updated": "2012-04-19",
        "status": "A",
        "authorized_official_last_name": "CARNAZZOLA",
        "authorized_official_first_name": "KIM",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-996-0607",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036085955",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Libertyville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 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.