Individual
CAROL L. WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5841 S MARYLAND AVE # MC3083, CHICAGO, IL 60637-1447
(773) 702-1439
Mailing address
180 HARVESTER DR STE 110, BURR RIDGE, IL 60527-6686
(773) 702-1150
Taxonomy
Speciality
Code
Description
License number
State
207ZB0001X
Blood Banking & Transfusion Medicine Physician
Primary
036141840
IL
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
22740
NE
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
42297
CO
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
5813
SD
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
7063A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
119945500
—
WY
05
—
47053951401
—
NE
05
—
806950700
—
ID
01
—
P00176481
RAILROAD MEDICARE
NE
Enumeration date
07/18/2006
Last updated
07/21/2022
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