MEDICARE: CARROLL FOOT & ANKLE CLINIC PC

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	213ES0103X	Foot & Ankle Surgery Podiatrist

General Provider Information

NPI Number	:	1922706522
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARROLL FOOT & ANKLE CLINIC PC

Provider Business Mailing Address
First Line	:	8849 SHELBY ST STE B1
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-6299
Country	:	US
Telephone Number	:	317-799-9000
Fax Number	:	317-561-4596

Provider Business Practice Location Address
First Line	:	8849 SHELBY ST STE B1
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-6299
Country	:	US
Telephone Number	:	317-799-9000
Fax Number	:	317-561-4596

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MICHAEL C CARROLL
Credential	:	DPM
Telephone Number	:	317-799-9000

Provider Enumeration Date	:	02/22/2023
Last Update Date	:	07/08/2023

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