Provider Demographics
NPI:1376535146
Name:KARAMICHOS, DEMETRIOS JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:DEMETRIOS
Middle Name:JOHN
Last Name:KARAMICHOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DEMETRIOS
Other - Middle Name:
Other - Last Name:KARAMICHOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:931 RIDGE RD STE C
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-1756
Mailing Address - Country:US
Mailing Address - Phone:219-595-3095
Mailing Address - Fax:219-881-8776
Practice Address - Street 1:931 RIDGE RD STE C
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-1756
Practice Address - Country:US
Practice Address - Phone:219-595-3095
Practice Address - Fax:219-881-8776
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36093881202K00000X
IN01064242A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036093881Medicaid
ILP00721116OtherMEDICARE RAILROAD
INP00468376OtherMEDICARE RAILROAD
INP00468376OtherMEDICARE RAILROAD
ILG57403Medicare UPIN
IL036093881Medicaid
ILK50524Medicare PIN
ILL61333Medicare ID - Type Unspecified