Provider Demographics
NPI:1588814024
Name:AL-KARAGHOULI, BAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BAN
Middle Name:
Last Name:AL-KARAGHOULI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7148 RELIABLE PKWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60686-0071
Mailing Address - Country:US
Mailing Address - Phone:313-745-0499
Mailing Address - Fax:313-833-8801
Practice Address - Street 1:4727 SAINT ANTOINE ST
Practice Address - Street 2:STE 304
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1461
Practice Address - Country:US
Practice Address - Phone:313-745-0499
Practice Address - Fax:313-833-8801
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-20
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282NW0100X
MI4301101736207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No282NW0100XHospitalsGeneral Acute Care HospitalWomen
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1588814024Medicaid