MEDICARE: DR. ROBERT JOHN CARROLL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	026319	LA
2	207R00000X	Internal Medicine Physician	4301102218	MI
3	208M00000X	Hospitalist Physician	4301102218	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013919380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT JOHN CARROLL M.D.

Provider Business Mailing Address
First Line	:	5000 HENNESSY BLVD
Second Line	:	FIRST FLOOR
City	:	BATON ROUGE
State	:	LA
Zip	:	70808-4375
Country	:	US
Telephone Number	:	225-765-4050
Fax Number	:	225-765-4046

Provider Business Practice Location Address
First Line	:	850 W BARAGA AVE
Second Line	:
City	:	MARQUETTE
State	:	MI
Zip	:	49855-4550
Country	:	US
Telephone Number	:	906-449-3000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	07/29/2021

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