Healthcare Provider Details

I. General information

NPI: 1669856092
Provider Name (Legal Business Name): MELODIE CARR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELODIE MIRANDA

II. Dates (important events)

Enumeration Date: 07/15/2015
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 BEAUBIEN
DETROIT MI
48201
US

IV. Provider business mailing address

3020 CHILDRENS WAY # MC5003
SAN DIEGO CA
92123-4223
US

V. Phone/Fax

Practice location:
  • Phone: 313-832-8290
  • Fax: 313-993-0081
Mailing address:
  • Phone: 858-309-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA145869
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301502867
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: