Provider Demographics
NPI:1518926252
Name:KARAOGLAN, DEHA (DPM)
Entity Type:Individual
Prefix:
First Name:DEHA
Middle Name:
Last Name:KARAOGLAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 4TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-4329
Mailing Address - Country:US
Mailing Address - Phone:707-526-4777
Mailing Address - Fax:707-526-8809
Practice Address - Street 1:1041 4TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4329
Practice Address - Country:US
Practice Address - Phone:707-526-4777
Practice Address - Fax:707-526-8809
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2020-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 3246213ES0103X
CAE4703213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00669152OtherMEDICARE RAIL ROAD
CA000E47030Medicare PIN
CA6505510002Medicare NSC
CAP00669152OtherMEDICARE RAIL ROAD
CA6677070001Medicare NSC
CA6505510001Medicare NSC