Carroll, Ivan Dale

Carroll, Ivan Dale is an individual health care provider with primary practice located at 17720 Cobblefield Ln , Spring Lake MI 49456-9264. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Public Health & General Preventive Medicine, Allopathic & Osteopathic Physicians / Obstetrics & Gynecology. Allopathic & Osteopathic Physicians / Obstetrics & Gynecology is his primary health care specialty. Carroll, Ivan Dale can be contacted via phone (616) 296-0622.

Contact Information

Primary practice address
17720 Cobblefield Ln Spring Lake MI 49456-9264
Phone: (616) 296-0622
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Public Health & General Preventive Medicine 2083P0901X 4301036938 Michigan
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X 5315171197 Michigan
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X 4301036938 Michigan

Profile Details

NPI number 1467476788
LBN Legal business name Carroll, Ivan Dale
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 27th, 2006
Last updated Jan 8th, 2021 - about 3 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 1467476788 NPPES
Michigan MEDICAID 4282462

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