Provider Demographics
NPI:1134149107
Name:CARL, JOHN C (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:CARL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9500 EUCLID AVE
Mailing Address - Street 2:A-120
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-445-7572
Mailing Address - Fax:216-445-7792
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:A-120
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-445-7572
Practice Address - Fax:216-445-7792
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35-0544382080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1134149107OtherMICHIGAN MEDICAID
OH363396OtherWELLCARE
PA0014868160003OtherPA MEDICAID
OH000000028086OtherANTHEM
OH0644193OtherAETNA
OH0866899Medicaid
OH727448OtherBUCKEYE
OH0866899OtherBCMH
OH000000221118OtherUNISON
OH000000525885OtherANTHEM
OH363396OtherWELLCARE
OH0866899Medicaid
OHF02504Medicare UPIN