Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | LO56 | OK |
N | 222Z00000X | Podiatrist | LO56 | OK |
Y | 224P00000X | Prosthetist | 90 | OK |
NPI | 1205170685 |
---|---|
Provider Name | Michael Carroll |
First Address | Oklahoma City, OK 73118-5031 |
Second Address | Oklahoma City, OK 73118-5031 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/11/2012 |
Last Update Date | 02/09/2013 |