Provider Demographics
NPI:1164517769
Name:CAROUBA, IZZAT ELIAS (MD)
Entity Type:Individual
Prefix:DR
First Name:IZZAT
Middle Name:ELIAS
Last Name:CAROUBA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3192 HEDGEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-4509
Mailing Address - Country:US
Mailing Address - Phone:248-230-7896
Mailing Address - Fax:
Practice Address - Street 1:29877 TELEGRAPH RD
Practice Address - Street 2:SUITE 401
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-7661
Practice Address - Country:US
Practice Address - Phone:248-354-0730
Practice Address - Fax:248-354-1652
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301079695207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine