Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | MD26082 | OR |
Y | 207PP0204X | Pediatric Emergency Physician | MD00045233 | WA |
NPI | 1114931375 |
---|---|
Provider Name | Meta L Carroll |
First Address | Chicago, IL 60614 |
Second Address | Arlington Heights, IL 60005-2349 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 29/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
213677 | (05) | OR |
8431017 | (05) | WA |
F67061 | (02) |