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General NPI Number Information
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NPI Number | 1023671989
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Entity Type | Individual
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Provider Name | MARQUES CARROLL
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Gender | Male
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Dates
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Enumeration Date | 04/17/2019
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Last Update Date | 04/16/2021
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Provider Practice Location Address
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Address Line | 8018 W CAPITOL DR # 105
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City | MILWAUKEE
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State | WI
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Zip | 53222-1906
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Country | US
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Telephone | 414-491-6962
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Fax | 414-488-1411
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Provider Business Mailing Address
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Address Line | 8018 W CAPITOL DR STE 105
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City | MILWAUKEE
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State | WI
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Zip | 53222-1906
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Country | US
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Telephone | 414-491-6962
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Fax | 414-488-1411
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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