Healthcare Provider Details

I. General information

NPI: 1548652423
Provider Name (Legal Business Name): DEI MCCARTY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2015
Last Update Date: 03/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2319 FAYE DR
ANN ARBOR MI
48103-3416
US

IV. Provider business mailing address

2319 FAYE DR
ANN ARBOR MI
48103-3416
US

V. Phone/Fax

Practice location:
  • Phone: 734-945-2623
  • Fax:
Mailing address:
  • Phone: 734-945-2623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: