Organization
FISCHER MANGOLD/JOLIET
Active
Organization
FISCHER MANGOLD/JOLIET
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD D. CARVOLTH M.D. (PRESIDENT)
(925) 924-1600
Entity
Organization
Contact information
Practice address
1200 MAPLE RD, JOLIET, IL 60432-1439
(925) 924-1600
(925) 924-0506
Mailing address
PO BOX 634717, CINCINNATI, OH 45263-0001
(925) 924-1600
(925) 924-0506
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CA2112
MEDICARE RR
IL
Enumeration date
05/09/2006
Last updated
10/19/2007
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