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General NPI Number Information
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NPI Number | 1235179201
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Entity Type | Individual
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Provider Name | CARL MICHAEL PESTA SR. DO
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Gender | Male
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 23575 15 MILE RD
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48035
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Country | US
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Telephone | 586-759-7494
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Fax | 734-677-7407
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Provider Business Mailing Address
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Address Line | PO BOX 1108
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City | ANN ARBOR
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State | MI
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Zip | 48106-1108
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Country | US
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Telephone | 586-759-7494
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Fax | 734-677-7407
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 5101005236
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License Number State | MI
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