Provider Demographics
NPI:1023671989
Name:CARROLL, MARQUES
Entity type:Individual
Prefix:
First Name:MARQUES
Middle Name:
Last Name:CARROLL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8018 W CAPITOL DR STE 105
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-1906
Mailing Address - Country:US
Mailing Address - Phone:414-491-6962
Mailing Address - Fax:414-488-1411
Practice Address - Street 1:8018 W CAPITOL DR # 105
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-1906
Practice Address - Country:US
Practice Address - Phone:414-491-6962
Practice Address - Fax:414-488-1411
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-17
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health