Healthcare Provider Details

I. General information

NPI: 1467731620
Provider Name (Legal Business Name): MONTY P KAROLL, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2011
Last Update Date: 08/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

639 YORK ST
QUINCY IL
62301-3963
US

IV. Provider business mailing address

200 N 8TH ST STE 99
QUINCY IL
62301-3062
US

V. Phone/Fax

Practice location:
  • Phone: 217-224-5031
  • Fax:
Mailing address:
  • Phone: 217-222-8874
  • Fax: 217-222-8874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number036064059
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number036064059
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number060007282
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number060007282
License Number StateIL

VIII. Authorized Official

Name: DR. MONTY P KAROLL
Title or Position: PRESIDENT
Credential: MD
Phone: 217-222-8874