Individual
JOHN RAYMOND CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1032 S CESAR E CHAVEZ DR, MILWAUKEE, WI 53204-2203
(414) 672-1353
(414) 672-4265
Mailing address
1032 S CESAR E CHAVEZ DR, MILWAUKEE, WI 53204-2203
(414) 672-1353
(414) 672-4265
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
31103
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31609200
—
WI
01
—
4567737
AETNA
WI
Enumeration date
02/08/2006
Last updated
03/07/2023
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