Healthcare Provider Details

I. General information

NPI: 1578637815
Provider Name (Legal Business Name): FIONA G CARROLL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FIONA G RUBENSTEIN MD

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18451 W 12 MILE RD STE 100
LATHRUP VILLAGE MI
48076-2635
US

IV. Provider business mailing address

18451 W 12 MILE RD STE 100
LATHRUP VILLAGE MI
48076-2635
US

V. Phone/Fax

Practice location:
  • Phone: 248-865-0030
  • Fax: 248-865-0034
Mailing address:
  • Phone: 248-865-0030
  • Fax: 248-865-0034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301088192
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: