Provider Demographics
NPI:1023045366
Name:CAROL FOULDS MD
Entity Type:Organization
Organization Name:CAROL FOULDS MD
Other - Org Name:MIDWEST DERMATOLOGY AND LASER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:FOULDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-387-1120
Mailing Address - Street 1:6730 W 121ST ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-2002
Mailing Address - Country:US
Mailing Address - Phone:913-387-1120
Mailing Address - Fax:913-663-1466
Practice Address - Street 1:6730 W 121ST ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-2002
Practice Address - Country:US
Practice Address - Phone:913-387-1120
Practice Address - Fax:913-663-1466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0430930207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADF9285OtherPALMETTO GBS MEDICARE RR
MO36148018OtherBCBSKC
KSW340000Medicare PIN
F43105Medicare UPIN