Organization
CARLSON ORTHOPEDIC CLINIC SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK E CARLSON MD (MD)
(815) 398-9100
Entity
Organization
Contact information
Practice address
1848 DAIMLER RD, ROCKFORD, IL 61112-1019
(815) 398-9100
(815) 986-6770
Mailing address
1848 DAIMLER RD, ROCKFORD, IL 61112-1019
(815) 398-9100
(815) 986-6770
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
036073115
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
216892
MEDICARE PTAN
IL
Enumeration date
08/31/2006
Last updated
09/08/2010
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