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General NPI Number Information
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NPI Number | 1962411090
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Entity Type | Individual
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Provider Name | JOEL CARROLL MD
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Gender | Male
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Dates
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Enumeration Date | 08/07/2006
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Last Update Date | 12/03/2018
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Provider Practice Location Address
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Address Line | 7322 236TH AVE
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City | SALEM
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State | WI
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Zip | 53168-9664
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Country | US
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Telephone | 262-577-8460
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Fax | 262-577-8399
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Provider Business Mailing Address
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Address Line | 6308 8TH AVE
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City | KENOSHA
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State | WI
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Zip | 53143-5031
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Country | US
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Telephone | 262-656-3313
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Fax | 262-577-8399
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 24302
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 24302-20
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License Number State | WI
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