Provider Demographics
NPI:1790737542
Name:CARELLA, MICHAEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:CARELLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1540 LAKE LANSING RD
Mailing Address - Street 2:STE 201
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3707
Mailing Address - Country:US
Mailing Address - Phone:517-913-3900
Mailing Address - Fax:517-913-3901
Practice Address - Street 1:1540 LAKE LANSING RD
Practice Address - Street 2:STE 201
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3707
Practice Address - Country:US
Practice Address - Phone:517-913-3900
Practice Address - Fax:517-913-3901
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301406434207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1001337OtherMCLAREN HEALTH PLAN-COMMERCIAL
MI4122546OtherAETNA
MI1103303831OtherBCBS/BCN
MI200000001715OtherPHP FAMILYCARE
MI110141707OtherRAILROAD MEDICARE
MI0M21440010OtherMEDICARE PLUS BLUE
MI4083567OtherMEDICAID
MI1001337OtherMCLAREN HEALTH ADVANTAGE
MI1001337OtherMCLAREN HEALTH PLAN-MEDICAID
MI200000001715OtherPHP
MI4848051Medicaid
MI200000001715OtherPHP FAMILYCARE
MI4083567OtherMEDICAID