Provider Demographics
NPI:1699748707
Name:CARROLL, MICHAEL PATTEN (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PATTEN
Last Name:CARROLL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:1020 29TH ST
Practice Address - Street 2:SUITE 680
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5125
Practice Address - Country:US
Practice Address - Phone:916-453-3313
Practice Address - Fax:916-453-3313
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32926207RH0003X
CAG88137207RH0003X
TXK0670207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ246448Medicaid
AZZWCGCROtherGROUP MEDICARE NUMBER
CAAS067ZMedicare PIN
AZ246448Medicaid
AZZ81214Medicare PIN