Provider Demographics
NPI:1114285707
Name:CARR, DANIEL AUGUSTEN (DO)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:AUGUSTEN
Last Name:CARR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22250 PROVIDENCE DR STE 601
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-6214
Mailing Address - Country:US
Mailing Address - Phone:248-569-7745
Mailing Address - Fax:
Practice Address - Street 1:22250 PROVIDENCE DR STE 601
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-6214
Practice Address - Country:US
Practice Address - Phone:248-569-7745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP60830303207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1114285707Medicaid