Provider Demographics
NPI:1114076056
Name:JOSEPH, KARIMAH AMATUALLAH (MD)
Entity Type:Individual
Prefix:
First Name:KARIMAH
Middle Name:AMATUALLAH
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1734
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48121-1734
Mailing Address - Country:US
Mailing Address - Phone:248-968-0349
Mailing Address - Fax:
Practice Address - Street 1:21700 GREENFIELD RD
Practice Address - Street 2:226
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2581
Practice Address - Country:US
Practice Address - Phone:248-968-0349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKJ062703207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4291944Medicaid
MI0P03070Medicare ID - Type Unspecified
MIG95883Medicare UPIN