MEDICARE: DR. BARBARA S CARLSON M.D.

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	207Q00000X	Family Medicine Physician	01059984A	IN
2	207Q00000X	Family Medicine Physician	4301066504	MI

General Provider Information

NPI Number	:	1710975529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARBARA S CARLSON M.D.

Provider Business Mailing Address
First Line	:	3950 HOLLYWOOD RD
Second Line	:	SUITE 100
City	:	SAINT JOSEPH
State	:	MI
Zip	:	49085-9159
Country	:	US
Telephone Number	:	269-429-8010
Fax Number	:

Provider Business Practice Location Address
First Line	:	5515 CLEVELAND AVENUE
Second Line	:	LAKELAND MEDICAL PRACTICES DBA SWMC
City	:	STEVENSVILLE
State	:	MI
Zip	:	49127-9613
Country	:	US
Telephone Number	:	261-429-9644
Fax Number	:	269-429-4002

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	01/31/2014

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