Basic Information
| Provider Information | |||||||||
| NPI: | 1740393594 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FLESSNER | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | CARR | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | CARR | ||||||||
| OtherFirstName: | CYNTHIA | ||||||||
| OtherMiddleName: | SUE | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6450 RELIABLE PARKWAY | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60686 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2177883000 | ||||||||
| FaxNumber: | 2177885577 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 N 1ST STREET | ||||||||
| Address2: | MEMORIAL MEDICAL CENTER DEPT OF PATHOLOGY | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 62781 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2177883060 | ||||||||
| FaxNumber: | 2177885577 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | IL | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 0360652021 | 05 | IL | MEDICAID |