Healthcare Provider Details

I. General information

NPI: 1497734230
Provider Name (Legal Business Name): CAROL GREER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 12/29/2020
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 TELEGRAPH RD EMERGENCY MEDICINE DEPARTMENT
TAYLOR MI
48180-3330
US

IV. Provider business mailing address

38935 ANN ARBOR RD CREDENTIALING/PAYER CONTRACTING
LIVONIA MI
48150-3397
US

V. Phone/Fax

Practice location:
  • Phone: 313-295-5007
  • Fax: 313-295-6725
Mailing address:
  • Phone: 734-632-0175
  • Fax: 734-632-0182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601004518
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: