Healthcare Provider Details

I. General information

NPI: 1568670156
Provider Name (Legal Business Name): MICHAEL ADELARD CARRON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5250 AUTO CLUB DR STE 290A
DEARBORN MI
48126-2619
US

IV. Provider business mailing address

400 MACK AVE. CREDENTIALING DEPT.
DETROIT MI
48201-2136
US

V. Phone/Fax

Practice location:
  • Phone: 313-448-9220
  • Fax:
Mailing address:
  • Phone: 313-448-9006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number4301080650
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number4301080650
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: