Healthcare Provider Details

I. General information

NPI: 1871015230
Provider Name (Legal Business Name): CHARLES MAY II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 07/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N SAGINAW ST
LAPEER MI
48446-4600
US

IV. Provider business mailing address

110 N SAGINAW ST STE 3
LAPEER MI
48446-4600
US

V. Phone/Fax

Practice location:
  • Phone: 810-535-5587
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: