Individual
IVAN DALE CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
17720 COBBLEFIELD LN, SPRING LAKE, MI 49456-9264
(616) 296-0622
Mailing address
17720 COBBLEFIELD LN, SPRING LAKE, MI 49456-9264
(616) 296-0622
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
4301036938
MI
207V00000X
Obstetrics & Gynecology Physician
5315171197
MI
2083P0901X
Public Health & General Preventive Medicine Physician
4301036938
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4282462
—
MI
Enumeration date
07/27/2006
Last updated
01/08/2021
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