Provider Demographics
NPI:1710975529
Name:CARLSON, BARBARA S (MD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:S
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3950 HOLLYWOOD RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-9159
Mailing Address - Country:US
Mailing Address - Phone:269-429-8010
Mailing Address - Fax:
Practice Address - Street 1:5515 CLEVELAND AVENUE
Practice Address - Street 2:LAKELAND MEDICAL PRACTICES DBA SWMC
Practice Address - City:STEVENSVILLE
Practice Address - State:MI
Practice Address - Zip Code:49127-9613
Practice Address - Country:US
Practice Address - Phone:261-429-9644
Practice Address - Fax:269-429-4002
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01059984A207Q00000X
MI4301066504207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IND89973Medicare UPIN
MIMI2051Medicare PIN