Provider Demographics
NPI:1811609159
Name:SAIN, CARL BEN JR
Entity type:Individual
Prefix:MR
First Name:CARL
Middle Name:BEN
Last Name:SAIN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3808 CAMELOT DR SE APT 1B
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6043
Mailing Address - Country:US
Mailing Address - Phone:616-500-4098
Mailing Address - Fax:
Practice Address - Street 1:3808 CAMELOT DR SE APT 1B
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6043
Practice Address - Country:US
Practice Address - Phone:616-500-4098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5803200207172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver