Provider Demographics
NPI:1164872420
Name:CARRICO, DAVID LEE (EMT-P, I/C)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LEE
Last Name:CARRICO
Suffix:
Gender:M
Credentials:EMT-P, I/C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19617 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:HARPER WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48225-2001
Mailing Address - Country:US
Mailing Address - Phone:313-343-2550
Mailing Address - Fax:313-343-2554
Practice Address - Street 1:19617 HARPER AVE
Practice Address - Street 2:
Practice Address - City:HARPER WOODS
Practice Address - State:MI
Practice Address - Zip Code:48225-2001
Practice Address - Country:US
Practice Address - Phone:313-343-2550
Practice Address - Fax:313-343-2554
Is Sole Proprietor?:No
Enumeration Date:2016-06-17
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3201011429146L00000X
MI3205002392146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic