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NPI Code Detail

MEDICARE: CARLA MARIE SOLOMON

MEDICARE: CARLA MARIE SOLOMON
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
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1932729472
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARLA MARIE SOLOMON
Provider Business Mailing Address
First Line : 801 YORK ST
Second Line :
City : MANITOWOC
State : WI
Zip : 54220-4630
Country : US
Telephone Number : 920-663-9008
Fax Number : 920-684-1439
Provider Business Practice Location Address
First Line : 1240 N MILWAUKEE AVE STE A
Second Line :
City : LIBERTYVILLE
State : IL
Zip : 60048-1307
Country : US
Telephone Number : 847-367-5575
Fax Number : 847-367-5579
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/24/2020
Last Update Date : 02/14/2025

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Directions to “ CARLA MARIE SOLOMON ” Practice Location

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