Provider Demographics
NPI:1063494706
Name:KAROUB, CARL M (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:M
Last Name:KAROUB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CARL
Other - Middle Name:M
Other - Last Name:KAROUB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4045 W 13 MILE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-6640
Mailing Address - Country:US
Mailing Address - Phone:248-288-2160
Mailing Address - Fax:248-288-0783
Practice Address - Street 1:4045 W 13 MILE RD
Practice Address - Street 2:SUITE A
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6640
Practice Address - Country:US
Practice Address - Phone:248-288-2160
Practice Address - Fax:248-288-0783
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301042923207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0636739OtherMEDICARE PLUS BLUE PPO
MI0636739OtherBCBS TRADITIONAL
MI0630777Medicare ID - Type Unspecified
P59510001Medicare PIN
A76139Medicare UPIN