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NPI Code Detail

MEDICARE: MISS CLARA C CARROLL PA

MEDICARE: MISS CLARA C CARROLL PA
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
1363AM0700XMedical Physician Assistant5601002157MI

General Provider Information

NPI Number : 1538190723
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS CLARA C CARROLL PA
Provider Business Mailing Address
First Line : 401 S BALLENGER HWY
Second Line :
City : FLINT
State : MI
Zip : 48532-3638
Country : US
Telephone Number : 810-342-1000
Fax Number : 810-342-1590
Provider Business Practice Location Address
First Line : 317 E GRAND RIVER RD
Second Line :
City : LAINGSBURG
State : MI
Zip : 48848-8742
Country : US
Telephone Number : 517-651-5018
Fax Number : 517-651-5288
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2006
Last Update Date : 07/08/2007

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Directions to “ MISS CLARA C CARROLL PA” Practice Location

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