MEDICARE: TODD E CARLSON 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	207P00000X	Emergency Medicine Physician	ME 96453	FL

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	:	1487651592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TODD E CARLSON M.D.

Provider Business Mailing Address
First Line	:	1432 BUTTERFIELD CT
Second Line	:
City	:	MARCO ISLAND
State	:	FL
Zip	:	34145-3812
Country	:	US
Telephone Number	:	239-970-2247
Fax Number	:

Provider Business Practice Location Address
First Line	:	8300 COLLIER BLVD
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34114-3549
Country	:	US
Telephone Number	:	239-354-6190
Fax Number	:

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

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	12/03/2009

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Directions to “ TODD E CARLSON M.D.” Practice Location

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