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Individual

DR. RICHARD PAUL CARROLL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
4887 E LAKE HARRIET BLVD, MINNEAPOLIS, MN 55419-5222
(612) 325-0317
Mailing address
4887 E LAKE HARRIET BLVD, MINNEAPOLIS, MN 55419-5222
(612) 325-0317

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
21566
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
31260500
WISCONSIN MA PROVIDER NO.
WI
05
648872200
MN
01
6D561CA
BCBS PROVIDER NUMBER
MN
Enumeration date
02/07/2006
Last updated
04/27/2010
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