Individual
CAROLYN FEDERMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4180 ROUTE 83, SUITE 10, LONG GROVE, IL 60047
(847) 686-0037
Mailing address
PO BOX 387, ADDISON, IL 60101-0387
(847) 686-0037
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4932106
BCBS PROVIDER NUMBER
IL
Enumeration date
09/20/2006
Last updated
07/08/2007
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