MEDICARE: DR. CARMY M MICHAEL DDS

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
1	1223G0001X	General Practice Dentistry	019040	MI

General Provider Information

NPI Number	:	1730216599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARMY M MICHAEL DDS

Provider Business Mailing Address
First Line	:	2020 DIVISION AVE S
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49507-3029
Country	:	US
Telephone Number	:	616-245-2767
Fax Number	:	616-245-0498

Provider Business Practice Location Address
First Line	:	2020 DIVISION AVE S
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49507-3029
Country	:	US
Telephone Number	:	616-245-2767
Fax Number	:	616-245-0498

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	07/08/2007

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