Individual
DEREK CARL CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
301 E SAINT JOSEPH ST, GREEN BAY, WI 54301-2241
(920) 433-3630
Mailing address
301 E SAINT JOSEPH ST, GREEN BAY, WI 54301-2241
(920) 433-3630
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
4301106248
MI
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
61608-20
WI
Other
Enumeration date
10/25/2005
Last updated
11/23/2020
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