Individual
LATISHA NICOLE CARTER-BLANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
39901 TRADITIONS DR, SUITE 240, NORTHVILLE, MI 48168-9493
(248) 888-9000
Mailing address
3621 S STATE ST, 700 KMS PLACE, ANN ARBOR, MI 48108
(734) 936-2047
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
4301079976
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1700923810
—
MI
Enumeration date
01/30/2007
Last updated
12/03/2014
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