1255457131 NPI number — DR. LINA N KARAM DMD

Table of content: DR. LINA N KARAM DMD (NPI 1255457131)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255457131 NPI number — DR. LINA N KARAM DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KARAM
Provider First Name:
LINA
Provider Middle Name:
N
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255457131
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1011 N UNIVERSITY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANN ARBOR
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48109-1078
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-764-1542
Provider Business Mailing Address Fax Number:
734-615-1415

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7200 DAN HOEY RD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEXTER
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48130-4201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-726-0760
Provider Business Practice Location Address Fax Number:
877-514-3452
Provider Enumeration Date:
03/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  2901017982 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223S0112X , with the licence number: 2901017982 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1958111880 . This is a "BCBS OF MI MED SURGICAL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: D179820 . This is a "BCBS OF MI DENTAL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4723610 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4723600 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com