Healthcare Provider Details

I. General information

NPI: 1710975529
Provider Name (Legal Business Name): BARBARA S CARLSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 01/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5515 CLEVELAND AVENUE LAKELAND MEDICAL PRACTICES DBA SWMC
STEVENSVILLE MI
49127-9613
US

IV. Provider business mailing address

3950 HOLLYWOOD RD SUITE 100
SAINT JOSEPH MI
49085-9159
US

V. Phone/Fax

Practice location:
  • Phone: 261-429-9644
  • Fax: 269-429-4002
Mailing address:
  • Phone: 269-429-8010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01059984A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301066504
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: