Healthcare Provider Details

I. General information

NPI: 1669427704
Provider Name (Legal Business Name): DAVID LEON CARTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 05/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S VAN DYKE ROAD
BAD AXE MI
48413
US

IV. Provider business mailing address

4420 VARSITY DR ATTN: BARB SIMMONS
ANN ARBOR MI
48108-2233
US

V. Phone/Fax

Practice location:
  • Phone: 989-269-9521
  • Fax: 989-269-5209
Mailing address:
  • Phone: 734-677-7400
  • Fax: 734-677-7400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301G48193
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: