Willis, Carol L.
Willis, Carol L. is an individual health care provider with primary practice located at 5841 S Maryland Ave # Mc3083 , Chicago IL 60637-1447. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology, Allopathic & Osteopathic Physicians / Blood Banking & Transfusion Medicine. Allopathic & Osteopathic Physicians / Blood Banking & Transfusion Medicine is her primary health care specialty. Willis, Carol L. can be contacted via phone (773) 702-1439.Contact Information
Primary practice address
5841 S Maryland Ave # Mc3083
Chicago IL 60637-1447
Phone: (773) 702-1439
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology | 207ZP0102X | 22740 | Nebraska |
| Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology | 207ZP0102X | 42297 | Colorado |
| Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology | 207ZP0102X | 7063A | Wyoming |
| Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology | 207ZP0102X | 5813 | South Dakota |
| Allopathic & Osteopathic Physicians / Blood Banking & Transfusion Medicine | 207ZB0001X | 036141840 | Illinois |
Profile Details
| NPI number | 1467471813 |
|---|---|
| LBN Legal business name | Willis, Carol L. |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 18th, 2006 |
| Last updated | Jul 21st, 2022 - about 4 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1467471813 | NPPES |
| Idaho | MEDICAID | 806950700 | |
| Idaho | MEDICAID | 47053951401 | |
| Idaho | MEDICAID | 119945500 | |
| Idaho | Other | P00176481 |
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