Healthcare Provider Details

I. General information

NPI: 1073379897
Provider Name (Legal Business Name): ERIC CARTER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2024
Last Update Date: 02/28/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15941 FAIRFIELD ST
DETROIT MI
48238-4123
US

IV. Provider business mailing address

2170 W JEFFERSON AVE
DETROIT MI
48216
US

V. Phone/Fax

Practice location:
  • Phone: 313-345-4310
  • Fax:
Mailing address:
  • Phone: 313-345-4310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: