Basic Information
| Provider Information | |||||||||
| NPI: | 1750375572 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOLDEN-BRENNER | ||||||||
| FirstName: | CARRIE | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GOLDEN | ||||||||
| OtherFirstName: | CARRIE | ||||||||
| OtherMiddleName: | E | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 800 AUSTIN | ||||||||
| Address2: | SUITE 151 | ||||||||
| City: | EVANSTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8473282300 | ||||||||
| FaxNumber: | 8474921988 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 AUSTIN | ||||||||
| Address2: | SUITE 151 | ||||||||
| City: | EVANSTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8473282300 | ||||||||
| FaxNumber: | 8474921988 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2005 | ||||||||
| LastUpdateDate: | 08/30/2012 | ||||||||
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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 | 207W00000X | 36-69488 | IL | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | 036.069488 | IL | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 036069488 | 05 | IL | MEDICAID | 01623637 | 01 | IL | BCBS NUMBER | OTHER | 01623637 | 01 | IL | BLUE SHIELD NUMBER | OTHER |