Organization
CSR PRIMARY CARE,LLC
Active
Organization
CSR PRIMARY CARE,LLC
Active
Other names
CSR Primary Care, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARY LANG CARNEY MD (OFFICER)
(847) 316-8700
Entity
Organization
Contact information
Practice address
800 AUSTIN ST, EAST TOWER #166, EVANSTON, IL 60202-3439
(847) 316-2100
Mailing address
800 AUSTIN ST, EAST TOWER #166, EVANSTON, IL 60202-3439
(847) 316-2100
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21623388
BLUE SHIELD OF ILLINOIS
IL
01
—
579340
MEDICARE
IL
Enumeration date
09/25/2007
Last updated
03/31/2015
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