Provider Demographics
NPI:1780682237
Name:CARRION, ERIBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIBERTO
Middle Name:
Last Name:CARRION
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 LINN ST
Mailing Address - Street 2:
Mailing Address - City:ALLEGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49010-1591
Mailing Address - Country:US
Mailing Address - Phone:269-686-5800
Mailing Address - Fax:269-686-5899
Practice Address - Street 1:406 N STATE ST
Practice Address - Street 2:
Practice Address - City:GOBLES
Practice Address - State:MI
Practice Address - Zip Code:49055-9717
Practice Address - Country:US
Practice Address - Phone:269-628-2196
Practice Address - Fax:269-628-2363
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI037432207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0130489OtherPHYSICANS HEALTH PLAN
MI1742371Medicaid
MIP68384OtherBLUE CARE NETWORK
MIP68384OtherBLUE CARE NETWORK
MIP39040027Medicare PIN