MEDICARE: MONTY P KAROLL, MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0200X	Radiology Clinic/Center	036064059	IL
2	261QR0208X	Mobile Radiology Clinic/Center	036064059	IL
3	261QR0208X	Mobile Radiology Clinic/Center	060007282	IL
4	261QR0200X	Radiology Clinic/Center	060007282	IL

General Provider Information

NPI Number	:	1467731620
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTY P KAROLL, MD PC

Provider Business Mailing Address
First Line	:	200 N 8TH ST STE 99
Second Line	:
City	:	QUINCY
State	:	IL
Zip	:	62301-3062
Country	:	US
Telephone Number	:	217-222-8874
Fax Number	:	217-222-8874

Provider Business Practice Location Address
First Line	:	639 YORK ST
Second Line	:
City	:	QUINCY
State	:	IL
Zip	:	62301-3963
Country	:	US
Telephone Number	:	217-224-5031
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MONTY P KAROLL
Credential	:	MD
Telephone Number	:	217-222-8874

Provider Enumeration Date	:	08/05/2011
Last Update Date	:	08/05/2011

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