Booth, Carol Witcraft

Booth, Carol Witcraft is an individual health care provider with primary practice located at 1875 Dempster St Suite 310, Park Ridge IL 60068-1186. She recently has only one registered license in Allopathic & Osteopathic Physicians / Clinical Genetics (M.D.), which is considered as her primary health care specialty. Booth, Carol Witcraft can be contacted via phone (847) 723-7705.

Contact Information

Primary practice address
1875 Dempster St Suite 310 Park Ridge IL 60068-1186
Phone: (847) 723-7705
Fax: (847) 723-8675
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Clinical Genetics (M.D.) 207SG0201X 036042710 Illinois

Profile Details

NPI number 1225072598
LBN Legal business name Booth, Carol Witcraft
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 16th, 2006
Last updated Mar 10th, 2009 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1225072598 NPPES
Other 460002585 RR MED PIN
MEDICAID 036042710 RR MED PIN
Other C19354 RR MED PIN

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