Provider Demographics
NPI:1295700631
Name:MORTON, CARLA E (MD)
Entity type:Individual
Prefix:DR
First Name:CARLA
Middle Name:E
Last Name:MORTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27209 LAHSER RD
Mailing Address - Street 2:SUITE 221
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-4744
Mailing Address - Country:US
Mailing Address - Phone:248-569-9330
Mailing Address - Fax:248-569-9360
Practice Address - Street 1:27209 LAHSER RD.
Practice Address - Street 2:SUITE 221
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-4744
Practice Address - Country:US
Practice Address - Phone:248-569-9330
Practice Address - Fax:248-569-9360
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301404971208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI383110480OtherTAX ID
MI383110480OtherTAX ID
MI0P03610Medicare ID - Type Unspecified