1245624410 NPI number — CARTER SPINAL ORTHOPEDIC AND SPORTS REHAB

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245624410 NPI number — CARTER SPINAL ORTHOPEDIC AND SPORTS REHAB

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARTER SPINAL ORTHOPEDIC AND SPORTS REHAB
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:
Provider Other Organization Name Type Code:
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:
1245624410
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20051 RENFREW RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48221-1391
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-341-5534
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27200 LAHSER RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SOUTHFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48034-2137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-341-5534
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/25/2015

Additional Information

Authorized Official

Authorized Official Last Name:
CARTER
Authorized Official First Name:
DENEEN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
313-341-5534

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  5501004885 , 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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