MEDICARE: CAROLYN EMILY NINE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	4301060058	MI

General Provider Information

NPI Number	:	1154437416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN EMILY NINE MD

Provider Business Mailing Address
First Line	:	26901 BEAUMONT BLVD STE 3D
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48033-3849
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	22646 E 9 MILE RD STE A
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48080-1951
Country	:	US
Telephone Number	:	586-498-4800
Fax Number	:	586-498-4830

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	01/06/2025

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