Provider Demographics
NPI:1376536185
Name:EMERICK, KARL (DO)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:
Last Name:EMERICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32901 23 MILE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-4063
Mailing Address - Country:US
Mailing Address - Phone:586-725-8500
Mailing Address - Fax:
Practice Address - Street 1:32901 23 MILE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-4063
Practice Address - Country:US
Practice Address - Phone:586-725-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI007581207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI010E06195OtherMI BCBSM
MI2770030Medicaid
MI010E06195OtherMI BCBSM
MI2770030Medicaid