Provider Demographics
NPI:1922706522
Name:CARROLL FOOT & ANKLE CLINIC PC
Entity Type:Organization
Organization Name:CARROLL FOOT & ANKLE CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:317-799-9000
Mailing Address - Street 1:8849 SHELBY ST STE B1
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-6299
Mailing Address - Country:US
Mailing Address - Phone:317-799-9000
Mailing Address - Fax:317-561-4596
Practice Address - Street 1:8849 SHELBY ST STE B1
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-6299
Practice Address - Country:US
Practice Address - Phone:317-799-9000
Practice Address - Fax:317-561-4596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-22
Last Update Date:2023-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty