Individual
CARLA PATRICE WATSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
730 45TH AVE, MUNSTER, IN 46321-2818
(219) 934-2652
(219) 934-2658
Mailing address
18660 GRAPHIC DR, STE 100, TINLEY PARK, IL 60477-6263
(708) 263-2000
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
036106614
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036106614
—
IL
01
—
363236791
TAX ID #
IL
Enumeration date
11/30/2006
Last updated
09/28/2017
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