Provider Demographics
NPI:1629046297
Name:KING, CAROL D (MD)
Entity Type:Individual
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First Name:CAROL
Middle Name:D
Last Name:KING
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Gender:F
Credentials:MD
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Mailing Address - Street 1:49650 CHERRY HILL RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-4849
Mailing Address - Country:US
Mailing Address - Phone:734-398-7880
Mailing Address - Fax:734-761-7318
Practice Address - Street 1:49650 CHERRY HILL RD
Practice Address - Street 2:SUITE 240
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-4849
Practice Address - Country:US
Practice Address - Phone:734-398-7880
Practice Address - Fax:734-761-7318
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2010-11-22
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Provider Licenses
StateLicense IDTaxonomies
MI4301068425207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G92981Medicare UPIN