Provider Demographics
NPI:1346589991
Name:KARASSI ENDOCRINOLOGY & INTERNAL MEDICINE PC
Entity Type:Organization
Organization Name:KARASSI ENDOCRINOLOGY & INTERNAL MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:S
Authorized Official - Last Name:WIDEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-787-2669
Mailing Address - Street 1:PO BOX 43039
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-0039
Mailing Address - Country:US
Mailing Address - Phone:205-787-2669
Mailing Address - Fax:205-787-2865
Practice Address - Street 1:817 PRINCETON AVE SW
Practice Address - Street 2:SUITE 308
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-1333
Practice Address - Country:US
Practice Address - Phone:205-787-2669
Practice Address - Fax:205-787-2865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-01
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G06561Medicare UPIN