Individual
JAMES EDWARD CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
6831 W 133RD AVE, CEDAR LAKE, IN 46303-8989
(219) 374-5970
(219) 374-7505
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02004028A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01826791
—
NY
05
—
201079400
—
IN
Enumeration date
11/20/2006
Last updated
04/14/2023
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