Individual
SALLY MADIBA-CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5841 S MARYLAND AVE # MC5068, CHICAGO, IL 60637-1443
(773) 702-9109
(773) 702-3135
Mailing address
180 HARVESTER DR STE 110, BURR RIDGE, IL 60527-6686
(773) 702-1150
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
036168225
IL
207P00000X
Emergency Medicine Physician
Primary
125078685
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/21/2019
Last updated
06/18/2024
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