Healthcare Provider Details

I. General information

NPI: 1972249894
Provider Name (Legal Business Name): SAMANTHA K CARSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA K PETERSON

II. Dates (important events)

Enumeration Date: 05/12/2022
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 DISCOVERY DR STE 400
LANSING MI
48910-8627
US

IV. Provider business mailing address

3101 DISCOVERY DR STE 400
LANSING MI
48910-8627
US

V. Phone/Fax

Practice location:
  • Phone: 517-975-3750
  • Fax: 517-975-3755
Mailing address:
  • Phone: 517-975-3750
  • Fax: 517-975-3755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301518692
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM-17425
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: