Provider Demographics
NPI:1558312942
Name:CARROLL, TY B (MD)
Entity Type:Individual
Prefix:DR
First Name:TY
Middle Name:B
Last Name:CARROLL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:W129N7055 NORTHFIELD DR
Mailing Address - Street 2:DIVISION OF ENDOCRINOLOGY
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-0538
Mailing Address - Country:US
Mailing Address - Phone:262-253-7155
Mailing Address - Fax:262-253-7140
Practice Address - Street 1:W129N7055 NORTHFIELD DR
Practice Address - Street 2:DIVISION OF ENDOCRINOLOGY
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-0538
Practice Address - Country:US
Practice Address - Phone:262-253-7155
Practice Address - Fax:262-253-7140
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI46886207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
007806261EOtherHUMANA
WI1558312942Medicaid
007806261EOtherHUMANA
WI73601 1393Medicare PIN