Provider Demographics
NPI:1962411090
Name:CARROLL, JOEL (MD)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:
Last Name:CARROLL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOEL
Other - Middle Name:PATRICK
Other - Last Name:CARROLL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6308 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53143-5031
Mailing Address - Country:US
Mailing Address - Phone:262-656-3313
Mailing Address - Fax:262-577-8399
Practice Address - Street 1:7322 236TH AVE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:WI
Practice Address - Zip Code:53168-9664
Practice Address - Country:US
Practice Address - Phone:262-577-8460
Practice Address - Fax:262-577-8399
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI24302207P00000X
WI24302-20207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30507800Medicaid
WIK400411276OtherMEDICARE
ILF400411291OtherMEDICARE (ILLINOIS)
WI30507800Medicaid
B51972Medicare UPIN