Individual
MR. JEREMY PHILIP CARLSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
251 E HURON ST, FEINBERG 5-704, CHICAGO, IL 60611-2908
(312) 926-8369
Mailing address
1262 W PRATT BLVD, APT 3, CHICAGO, IL 60626-4382
(847) 769-4836
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
041.356505
IL
Other
Enumeration date
10/28/2011
Last updated
10/28/2011
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