Provider Demographics
NPI:1487655932
Name:CARROLL, MICHAEL LINDSEY (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LINDSEY
Last Name:CARROLL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:LINDSEY
Other - Last Name:CARROLL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:9208 ELAM RD
Mailing Address - Street 2:STE 220
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75217-4178
Mailing Address - Country:US
Mailing Address - Phone:214-398-3251
Mailing Address - Fax:214-398-7251
Practice Address - Street 1:9208 ELAM RD
Practice Address - Street 2:STE 220
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75217-4178
Practice Address - Country:US
Practice Address - Phone:214-398-3251
Practice Address - Fax:214-398-7251
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3813207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099398202Medicaid
TX00LP64Medicare PIN
TX099398202Medicaid