Individual
MARISA A CARTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1127 N OAKLEY BLVD FL 2, CHICAGO, IL 60622-3507
(312) 770-2040
Mailing address
1127 N OAKLEY BLVD FL 2, CHICAGO, IL 60622-3507
(312) 770-2040
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036.162765
IL
390200000X
Student in an Organized Health Care Education/Training Program
125.074315
IL
Other
Enumeration date
05/29/2019
Last updated
03/14/2023
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