Provider Demographics
NPI:1265478671
Name:FRAM, KARIM MOUSA (MD)
Entity Type:Individual
Prefix:DR
First Name:KARIM
Middle Name:MOUSA
Last Name:FRAM
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:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-0190
Mailing Address - Country:US
Mailing Address - Phone:810-667-9132
Mailing Address - Fax:810-667-0023
Practice Address - Street 1:237 DAVIS LAKE RD
Practice Address - Street 2:SUITE B
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-1466
Practice Address - Country:US
Practice Address - Phone:810-667-9132
Practice Address - Fax:810-667-0026
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010478562084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI18237325-10Medicaid
MIOP28750Medicare PIN
MI18237325-10Medicaid