| Carl M. Wahlstrom, Jr., M.d., Limited | |
|
307 N Michigan Ave Suite 1008 Chicago IL 60601-5311 | |
| (312) 782-7895 | |
| (312) 782-7897 |
| Full Name | Carl M. Wahlstrom, Jr., M.d., Limited |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 307 N Michigan Ave, Chicago, Illinois |
| Authorized Official Name and Position | Carl M Wahlstrom (PRESIDENT) |
| Authorized Official Contact | 3127827895 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Carl M. Wahlstrom, Jr., M.d., Limited 307 N Michigan Ave Suite 1008 Chicago IL 60601-5311 Ph: (312) 782-7895 | Carl M. Wahlstrom, Jr., M.d., Limited 307 N Michigan Ave Suite 1008 Chicago IL 60601-5311 Ph: (312) 782-7895 |
| NPI Number | 1912190901 |
|---|---|
| Provider Enumeration Date | 08/22/2007 |
| Last Update Date | 08/22/2007 |
| Medicare PECOS PAC ID | 1254314693 |
|---|---|
| Medicare Enrollment ID | O20040609000063 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912190901 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (Illinois) | Primary |
| Provider Name | Carl M Wahlstrom |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1255498945 PECOS PAC ID: 4183607484 Enrollment ID: I20040614001134 |
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