Individual
MICHAEL CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
602 W UNIVERSITY AVE, URBANA, IL 61801-2530
(217) 383-3311
Mailing address
602 W UNIVERSITY AVE, URBANA, IL 61801-2530
(217) 383-3311
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
036084204
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050021669
RAILROAD NUMBER
IL
01
—
1457386351
NPI
IL
Enumeration date
07/11/2006
Last updated
06/05/2012
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