Individual
DR. CAROL WITCRAFT BOOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1875 DEMPSTER ST, SUITE 310, PARK RIDGE, IL 60068-1186
(847) 723-7705
(847) 723-8675
Mailing address
1875 DEMPSTER ST, SUITE 310, PARK RIDGE, IL 60068-1186
(847) 723-7705
(847) 723-8675
Taxonomy
Speciality
Code
Description
License number
State
207SG0201X
Clinical Genetics (M.D.) Physician
Primary
036042710
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036042710
—
IL
01
—
460002585
RR MED PIN
—
01
—
C19354
RR MED GROUP
—
Enumeration date
06/16/2006
Last updated
03/10/2009
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