Carroll, Elaine Marie

Carroll, Elaine Marie is an individual health care provider with primary practice located at 1508 W Reynolds St , Pontiac IL 61764-2811. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Maternal & Fetal Medicine, Allopathic & Osteopathic Physicians / Obstetrics & Gynecology. Allopathic & Osteopathic Physicians / Obstetrics & Gynecology is her primary health care specialty. Carroll, Elaine Marie can be contacted via phone (815) 844-4611.

Contact Information

Primary practice address
1508 W Reynolds St Pontiac IL 61764-2811
Phone: (815) 844-4611
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Maternal & Fetal Medicine 207VM0101X 01076901A Indiana
Allopathic & Osteopathic Physicians / Maternal & Fetal Medicine 207VM0101X 036085505 Illinois
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X 36085505 Illinois

Profile Details

NPI number 1598739492
LBN Legal business name Carroll, Elaine Marie
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 15th, 2006
Last updated Apr 20th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1598739492 NPPES
Illinois Other 206147 MEDICARE PTAN (GROUP)
Illinois MEDICAID 036085505 MEDICARE PTAN (GROUP)
Illinois Other 206147098 MEDICARE PTAN (GROUP)
Illinois Other 181980007 MEDICARE PTAN (GROUP)
Illinois MEDICAID 200265610 MEDICARE PTAN (GROUP)

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