1407803182 NPI number — KATHERINE KARO DO

Table of content: KATHERINE KARO DO (NPI 1407803182)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407803182 NPI number — KATHERINE KARO DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KARO
Provider First Name:
KATHERINE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1407803182
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/31/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50581 LANGLEY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NOVI
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48374-2528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-535-8555
Provider Business Mailing Address Fax Number:
248-535-8555

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50581 LANGLEY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NOVI
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48374-2528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-535-8555
Provider Business Practice Location Address Fax Number:
248-535-8555
Provider Enumeration Date:
05/28/2006

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: 208100000X , with the licence number:  KK013414 , 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: 5101013414 . This is a "CDS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 11280027 . This is a "CAQH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 114707438 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5101013414 . This is a "STATE LICENSE #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5822408 . This is a "TYPE 1 BCBS PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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