Edward E Carlson, MD
Individual provider Active NPI Family Medicine Physician · Elkhorn, WI
NPI 1114036738 · NPPES record last updated Nov 11, 2014
Key facts
- NPI
- 1114036738
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 18826 (WI)
- Practice address
- 433 Oakland LN
Elkhorn, WI 53121-1659 - Phone
- (262) 723-4455
- NPI assigned
- Aug 29, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18826 | WI | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mercy Health System Corporation | Current | Accepting new patients |
Locations
29624 Network Pl
Chicago, IL 60673
Phone (608) 741-7652
2310 1st Center Ave
Brodhead, WI 53520
Phone (608) 897-8664
1038 E Geneva St
Delavan, WI 53115
Phone (262) 728-4301
1000 Mineral Point Ave
Janesville, WI 53548
Phone (608) 261-6868
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 18826 | WI | Yes |
Addresses
Primary practice location
433 Oakland LN
Elkhorn, WI 53121-1659
Mailing address
433 Oakland LN
Elkhorn, WI 53121-1659
Phone (262) 723-4455
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0161173024 1 | Medicaid | IL | |
| 31204000 | Medicaid | WI |
Other providers in Elkhorn, WI
- Traci L Bulow
- Megan Burg
- Lindsey Jo Provenzano Burgess
- Kevin Bushey
- Alex C Canda
- Julie A Chapman
- Children'S Hospital of Wisconsin
- Chiropractic Center of Elkhorn LLC
- Chiros in Motion
- Lee Joel Christensen
All providers in Elkhorn, WI · Family Medicine Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 11, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.