Individual
JEFFREY CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
225 MEMORIAL DR STE 1400, BERLIN, WI 54923-1243
(920) 361-5760
(920) 361-5766
Mailing address
225 MEMORIAL DR STE 1400, BERLIN, WI 54923-1243
(920) 361-5760
(920) 361-5766
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
22313-020
WI
208600000X
Surgery Physician
22313-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30398700
—
WI
Enumeration date
08/02/2005
Last updated
12/24/2009
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