MEDICARE: DR. JOHN A CARR MD

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	208600000X	Surgery Physician	036106764	IL
2	208600000X	Surgery Physician	4301067523	MI
3	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	4301067523	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00320817	OTHER	IL	RR MEDICARE PIN
8	CB3741	OTHER	IL	RR MEDICARE GROUP #

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
2	286294	OTHER	IL	PERSONAL CARE
3	370661230	OTHER	IL	TAXPAYER ID #
5	036106764	OTHER	IL	IL STATE LICENSE
6	752951	OTHER	IL	HEALTHLINK
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	06932023	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1457353658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN A CARR MD

Provider Business Mailing Address
First Line	:	5943 STADIUM DR
Second Line	:	STE 1
City	:	KALAMAZOO
State	:	MI
Zip	:	49009-3016
Country	:	US
Telephone Number	:	269-552-2836
Fax Number	:	269-552-2964

Provider Business Practice Location Address
First Line	:	1717 SHAFFER ST
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49048-1647
Country	:	US
Telephone Number	:	269-226-5456
Fax Number	:	269-226-4940

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	07/08/2021

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Directions to “ DR. JOHN A CARR MD” Practice Location

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