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General NPI Number Information
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NPI Number | 1598739492
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Entity Type | Individual
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Provider Name | ELAINE MARIE CARROLL MD
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Gender | Female
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Dates
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Enumeration Date | 02/15/2006
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Last Update Date | 04/20/2022
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Provider Practice Location Address
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Address Line | 1508 W REYNOLDS ST
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City | PONTIAC
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State | IL
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Zip | 61764-2811
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Country | US
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Telephone | 815-844-4611
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Fax |
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Provider Business Mailing Address
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Address Line | 611 W PARK ST
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City | URBANA
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State | IL
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Zip | 61801-2529
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Country | US
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Telephone |
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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 | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number | 01076901A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number | 036085505
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 36085505
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License Number State | IL
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