Provider Demographics
NPI:1609876978
Name:CARROLL, MICHAEL G (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:G
Last Name:CARROLL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6801 DIXIE HWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40258-3913
Mailing Address - Country:US
Mailing Address - Phone:502-361-8496
Mailing Address - Fax:502-361-3377
Practice Address - Street 1:1460 BLUEGRASS AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1272
Practice Address - Country:US
Practice Address - Phone:502-361-8496
Practice Address - Fax:502-361-3377
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2013-04-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY16212207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6590070600Medicaid
IN100003350Medicaid
KY0546001Medicare ID - Type UnspecifiedMEDICARE CARITAS OFFICE
IN100003350Medicaid
KY00546243Medicare Oscar/Certification
KYP00777639Medicare PIN