MEDICARE: FIONA G CARROLL 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	208000000X	Pediatrics Physician	4301088192	MI

General Provider Information

NPI Number	:	1578637815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FIONA G CARROLL M.D.

Provider Business Mailing Address
First Line	:	18451 W 12 MILE RD STE 100
Second Line	:
City	:	LATHRUP VILLAGE
State	:	MI
Zip	:	48076-2635
Country	:	US
Telephone Number	:	248-865-0030
Fax Number	:	248-865-0034

Provider Business Practice Location Address
First Line	:	18451 W 12 MILE RD STE 100
Second Line	:
City	:	LATHRUP VILLAGE
State	:	MI
Zip	:	48076-2635
Country	:	US
Telephone Number	:	248-865-0030
Fax Number	:	248-865-0034

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

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	12/15/2025

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