Provider Demographics
NPI:1174222855
Name:CARTHAN, BLAKE A
Entity type:Individual
Prefix:
First Name:BLAKE
Middle Name:A
Last Name:CARTHAN
Suffix:
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 1:24600 SHERMAN ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-1841
Mailing Address - Country:US
Mailing Address - Phone:248-416-6910
Mailing Address - Fax:
Practice Address - Street 1:24600 SHERMAN ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-1841
Practice Address - Country:US
Practice Address - Phone:248-416-6910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health