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NPI Code Detail

MEDICARE: DR. THEADIA LARUE CAREY MD

MEDICARE: DR. THEADIA LARUE CAREY MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0802XAddiction Psychiatry Physician4301076021MI
22084P0800XPsychiatry Physician4301076021MI

General Provider Information

NPI Number : 1699897728
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THEADIA LARUE CAREY MD
Provider Business Mailing Address
First Line : 17320 W 12 MILE RD STE 101
Second Line :
City : SOUTHFIELD
State : MI
Zip : 48076-2102
Country : US
Telephone Number : 248-838-9852
Fax Number :
Provider Business Practice Location Address
First Line : 17320 W 12 MILE RD STE 101
Second Line :
City : SOUTHFIELD
State : MI
Zip : 48076-2102
Country : US
Telephone Number : 248-727-3456
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2007
Last Update Date : 04/08/2026

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