Provider Demographics
NPI:1639413891
Name:KARMO, TARA S (PA)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:S
Last Name:KARMO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:S
Other - Last Name:SHAMOON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30055 NORTHWESTERN HWY
Mailing Address - Street 2:STE 250
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3230
Mailing Address - Country:US
Mailing Address - Phone:248-985-5555
Mailing Address - Fax:248-985-5555
Practice Address - Street 1:30055 NORTHWESTERN HWY
Practice Address - Street 2:STE 250
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3230
Practice Address - Country:US
Practice Address - Phone:248-985-5555
Practice Address - Fax:248-985-5555
Is Sole Proprietor?:No
Enumeration Date:2012-11-12
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006347363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5601006347OtherMICHIGAN STATE PHYSICIAN ASSISTANT