MEDICARE: DR. JOEL CARROLL MD

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	24302	WI
2	207Q00000X	Family Medicine Physician	24302-20	WI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	K400411276	OTHER	WI	MEDICARE
3	F400411291	OTHER	IL	MEDICARE (ILLINOIS)

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	:	1962411090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOEL CARROLL MD

Provider Business Mailing Address
First Line	:	6308 8TH AVE
Second Line	:
City	:	KENOSHA
State	:	WI
Zip	:	53143-5031
Country	:	US
Telephone Number	:	262-656-3313
Fax Number	:	262-577-8399

Provider Business Practice Location Address
First Line	:	7322 236TH AVE
Second Line	:
City	:	SALEM
State	:	WI
Zip	:	53168-9664
Country	:	US
Telephone Number	:	262-577-8460
Fax Number	:	262-577-8399

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

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	12/03/2018

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Directions to “ DR. JOEL CARROLL MD” Practice Location

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