MEDICARE: CAROL JEANNE SHOWALTER 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	208100000X	Physical Medicine & Rehabilitation Physician	38304	WI
2	208100000X	Physical Medicine & Rehabilitation Physician	32511	MN

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	:	1467414300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL JEANNE SHOWALTER MD

Provider Business Mailing Address
First Line	:	PO BOX 43
Second Line	:	MR 10809
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55440-0043
Country	:	US
Telephone Number	:	612-262-4813
Fax Number	:	612-262-4194

Provider Business Practice Location Address
First Line	:	280 SMITH AVE N
Second Line	:	SUITE 737
City	:	SAINT PAUL
State	:	MN
Zip	:	55102-2424
Country	:	US
Telephone Number	:	651-241-8295
Fax Number	:	651-241-7300

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

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	07/08/2007

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Directions to “ CAROL JEANNE SHOWALTER MD” Practice Location

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