Provider Demographics
NPI:1588765804
Name:CARNAHAN, JANE MARIE (MD)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:MARIE
Last Name:CARNAHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3626 N DIXBORO RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9707
Mailing Address - Country:US
Mailing Address - Phone:734-663-0277
Mailing Address - Fax:
Practice Address - Street 1:2215 FULLER RD
Practice Address - Street 2:MENTAL HEALTH CLINIC, 116C
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-2335
Practice Address - Country:US
Practice Address - Phone:734-769-7100
Practice Address - Fax:734-769-7416
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010509712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry