Organization
FABIAN CARBONELL MD SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FABIAN CARBONELL MD (PRESIDENT)
(773) 649-4261
Entity
Organization
Contact information
Practice address
331 W SURF ST STE 708, CHICAGO, IL 60657-7227
(773) 649-4261
(872) 243-2843
Mailing address
331 W SURF ST STE 708, CHICAGO, IL 60657-7227
(773) 649-4261
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
036098028
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036098028
—
IL
Enumeration date
06/12/2007
Last updated
11/17/2023
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