Provider Demographics
NPI:1477758571
Name:DAIGLE, CARRIE A (MD)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:A
Last Name:DAIGLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:A
Other - Last Name:LINNERTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1019 VALMEYER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:IL
Mailing Address - Zip Code:62236-4123
Mailing Address - Country:US
Mailing Address - Phone:618-205-7170
Mailing Address - Fax:618-205-7171
Practice Address - Street 1:1019 VALMEYER RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:IL
Practice Address - Zip Code:62236-4123
Practice Address - Country:US
Practice Address - Phone:618-205-7170
Practice Address - Fax:618-205-7171
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036125646207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC299064Medicaid
SCRES0001124Medicare PIN
SCRES0001127Medicare PIN
SCRES000Medicare UPIN
ILPENDINGMedicare PIN