Healthcare Provider Details

I. General information

NPI: 1003975863
Provider Name (Legal Business Name): MICHAEL HARRIS CARPENTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2006
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 S STEPHENSON AVE STE 210
IRON MOUNTAIN MI
49801-3649
US

IV. Provider business mailing address

PO BOX 549
IRON MOUNTAIN MI
49801-0549
US

V. Phone/Fax

Practice location:
  • Phone: 906-776-5800
  • Fax: 906-228-0200
Mailing address:
  • Phone: 906-774-1313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD431231
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberEMC0000102
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: