Provider Demographics
NPI:1932729472
Name:SOLOMON, CARLA MARIE
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:MARIE
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:1240 N MILWAUKEE AVE STE A
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-1307
Practice Address - Country:US
Practice Address - Phone:847-367-5575
Practice Address - Fax:847-367-5579
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-24
Last Update Date:2025-02-14
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant