Healthcare Provider Details

I. General information

NPI: 1760977169
Provider Name (Legal Business Name): ADAM CARR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 07/16/2023
Certification Date: 07/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 N WILLOWBROOK RD
COLDWATER MI
49036-9462
US

IV. Provider business mailing address

401 W GREENLAWN AVE
LANSING MI
48910-2819
US

V. Phone/Fax

Practice location:
  • Phone: 517-278-8727
  • Fax:
Mailing address:
  • Phone: 517-975-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number5101025846
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: