MEDICARE: DIANE CARPENTER 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	208000000X	Pediatrics Physician	28751	WI

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	:	1467409888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE CARPENTER MD

Provider Business Mailing Address
First Line	:	2555 N MLK DR
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-2709
Country	:	US
Telephone Number	:	414-372-8080
Fax Number	:

Provider Business Practice Location Address
First Line	:	2555 N MLK DR
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-2709
Country	:	US
Telephone Number	:	414-372-8080
Fax Number	:

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

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	01/30/2008

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Directions to “ DIANE CARPENTER MD” Practice Location

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