1962746743 NPI number — CAR MD

Table of content: (NPI 1962746743)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962746743 NPI number — CAR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAR MD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
C.A.R. MD, PLLC
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962746743
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9626 STINCHFIELD WOODS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PINCKNEY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48169-9404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-478-1242
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
47601 GRAND RIVER AVE
Provider Second Line Business Practice Location Address:
SUITE B-223
Provider Business Practice Location Address City Name:
NOVI
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48374-1233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-465-5320
Provider Business Practice Location Address Fax Number:
248-465-5321
Provider Enumeration Date:
11/19/2012

Additional Information

Authorized Official

Authorized Official Last Name:
RUBLE
Authorized Official First Name:
CHERYL
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
734-478-1242

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X , with the licence number:  4301406400 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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