Healthcare Provider Details

I. General information

NPI: 1790737542
Provider Name (Legal Business Name): MICHAEL J. CARELLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 09/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 LAKE LANSING RD STE 201
LANSING MI
48912-3707
US

IV. Provider business mailing address

1540 LAKE LANSING RD STE 201
LANSING MI
48912-3707
US

V. Phone/Fax

Practice location:
  • Phone: 517-913-3900
  • Fax: 517-913-3901
Mailing address:
  • Phone: 517-913-3900
  • Fax: 517-913-3901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number4301406434
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: