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General NPI Number Information
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NPI Number | 1477044394
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Entity Type | Individual
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Provider Name | GARRETT MICHAEL CARPENTER DO
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Gender | Male
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Dates
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Enumeration Date | 05/26/2018
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Last Update Date | 07/21/2024
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Provider Practice Location Address
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Address Line | 2355 HWY 36 W. STE. 100
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City | ROSEVILLE
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State | MN
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Zip | 55113
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Country | US
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Telephone | 651-292-2000
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Fax | 314-747-4189
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Provider Business Mailing Address
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Address Line | 2355 HWY 36 W. STE. 100
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City | ROSEVILLE
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State | MN
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Zip | 55113
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Country | US
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Telephone | 651-292-2000
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Fax |
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 2023006679
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 75433
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License Number State | MN
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