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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