Larsen, Camilla Z

Larsen, Camilla Z is an individual health care provider with primary practice located at 2160 S 1St Ave , Maywood IL 60153-3328. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Larsen, Camilla Z can be contacted via phone (708) 216-1116.

Contact Information

Primary practice address
2160 S 1St Ave Maywood IL 60153-3328
Phone: (708) 216-1116
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 036108645 Illinois

Profile Details

NPI number 1336151752
LBN Legal business name Larsen, Camilla Z
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 13th, 2006
Last updated Feb 2nd, 2022 - about 3 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 1336151752 NPPES
Illinois MEDICAID 036108645
Illinois Other 12419687

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