MEDICARE: DR. CAROL PRINCE M.D.

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	207N00000X	Dermatology Physician	262140	NY
2	207N00000X	Dermatology Physician	53005	WI
3	207N00000X	Dermatology Physician	4301038363	MI

General Provider Information

NPI Number	:	1922206580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROL PRINCE M.D.

Provider Business Mailing Address
First Line	:	1610 WEST SEVEN MILE RD.
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48203
Country	:	US
Telephone Number	:	313-595-3391
Fax Number	:

Provider Business Practice Location Address
First Line	:	1610 WEST SEVEN MILE RD.
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48203
Country	:	US
Telephone Number	:	313-595-3391
Fax Number	:

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

Provider Enumeration Date	:	07/05/2007
Last Update Date	:	03/05/2013

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Directions to “ DR. CAROL PRINCE M.D.” Practice Location

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