Provider Demographics
NPI:1609944487
Name:NORMAN J KAKOS MD PC
Entity Type:Organization
Organization Name:NORMAN J KAKOS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:JOHNNY
Authorized Official - Last Name:KAKOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-399-5492
Mailing Address - Street 1:32121 WOODWARD AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-6237
Mailing Address - Country:US
Mailing Address - Phone:248-399-5492
Mailing Address - Fax:248-399-5792
Practice Address - Street 1:32121 WOODWARD AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6237
Practice Address - Country:US
Practice Address - Phone:248-399-5492
Practice Address - Fax:248-399-5792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068130207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110F338430OtherBCBS GROUP
MI1106334721OtherBCBS BCN
MI4422877Medicaid
MI1106334721OtherBCBS BCN
MI110F338430OtherBCBS GROUP
MIH01743Medicare UPIN