Provider Demographics
NPI:1629699731
Name:MELDRUM, CARINE RAE (PA-C)
Entity Type:Individual
Prefix:
First Name:CARINE
Middle Name:RAE
Last Name:MELDRUM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CARINE
Other - Middle Name:RAE
Other - Last Name:GUSTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:30150 TELEGRAPH RD STE 271
Mailing Address - Street 2:
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4521
Mailing Address - Country:US
Mailing Address - Phone:248-395-5166
Mailing Address - Fax:
Practice Address - Street 1:19176 HALL RD STE 110
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-6914
Practice Address - Country:US
Practice Address - Phone:586-286-3400
Practice Address - Fax:586-286-3619
Is Sole Proprietor?:No
Enumeration Date:2020-04-29
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant