Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | EMC0000102 | MI |
N | 208000000X | Pediatrician | MD431231 | PA |
NPI | 1003975863 |
---|---|
Provider Name | Dr. Michael Harris Carpenter |
First Address | Iron Mountain, MI 49801-0549 |
Second Address | Iron Mountain, MI 49801-3649 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2006 |
Last Update Date | 18/02/2020 |