Provider Demographics
NPI:1427051291
Name:CARROLL, MICHAEL C (DPM)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:CARROLL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8849 SHELBY ST STE B1
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-6299
Mailing Address - Country:US
Mailing Address - Phone:317-799-9000
Mailing Address - Fax:317-561-4596
Practice Address - Street 1:8849 SHELBY ST STE B1
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-6299
Practice Address - Country:US
Practice Address - Phone:317-799-9000
Practice Address - Fax:317-561-4596
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2023-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000970A213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INV00224Medicare UPIN
4691620001Medicare NSC
IN265340DMedicare PIN