Healthcare Provider Details

I. General information

NPI: 1447332747
Provider Name (Legal Business Name): MICHAEL MCCARTAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 MILITARY ST
PORT HURON MI
48060-5416
US

IV. Provider business mailing address

709 N 9TH ST
SAINT CLAIR MI
48079-5489
US

V. Phone/Fax

Practice location:
  • Phone: 810-985-8900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801014618
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: