Provider Demographics
NPI:1861501744
Name:CARPENTER, CREG A (MD)
Entity Type:Individual
Prefix:
First Name:CREG
Middle Name:A
Last Name:CARPENTER
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 1:24 FRANK LLOYD WRIGHT DR.
Mailing Address - Street 2:LOBBY J2000
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48106
Mailing Address - Country:US
Mailing Address - Phone:734-593-5700
Mailing Address - Fax:734-593-5705
Practice Address - Street 1:14650 E. OLD US HWY 12
Practice Address - Street 2:SUITE 105
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118
Practice Address - Country:US
Practice Address - Phone:734-593-5700
Practice Address - Fax:734-593-5705
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICC084682207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI1993003Medicare PIN
MIG60705Medicare UPIN