Provider Demographics
NPI:1629005103
Name:TURCOTT, CAROLYN J (MD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:J
Last Name:TURCOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 N MAYFAIR RD
Mailing Address - Street 2:SUITE 785
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1309
Mailing Address - Country:US
Mailing Address - Phone:414-258-5704
Mailing Address - Fax:414-258-8406
Practice Address - Street 1:2600 N MAYFAIR RD
Practice Address - Street 2:SUITE 785
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-1309
Practice Address - Country:US
Practice Address - Phone:414-258-5704
Practice Address - Fax:414-258-8406
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI449590202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34317200Medicaid
WI000484137Medicare ID - Type Unspecified
WI34317200Medicaid