MEDICARE: DR. BRIAN A MCCARROLL D.O.

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	207Q00000X	Family Medicine Physician	BM007710	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	104279	OTHER	MI	CARE CHOICES
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000549480	OTHER	MI	UNITED HEALTH CARE
4	2351230003	OTHER	MI	CIGNA HEALTH CARE
5	0154410164	OTHER	MI	BCBS OF MI
6	C8031	OTHER	MI	M-CARE

General Provider Information

NPI Number	:	1093779670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN A MCCARROLL D.O.

Provider Business Mailing Address
First Line	:	80600 VAN DYKE RD
Second Line	:
City	:	BRUCE TWP
State	:	MI
Zip	:	48065-1333
Country	:	US
Telephone Number	:	810-798-6560
Fax Number	:	810-798-6563

Provider Business Practice Location Address
First Line	:	80600 VAN DYKE RD
Second Line	:
City	:	BRUCE TWP
State	:	MI
Zip	:	48065-1333
Country	:	US
Telephone Number	:	810-798-6560
Fax Number	:	810-798-6563

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

Provider Enumeration Date	:	04/12/2006
Last Update Date	:	11/23/2009

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Directions to “ DR. BRIAN A MCCARROLL D.O.” Practice Location

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