Provider Demographics
NPI:1679554562
Name:KAROUB, FREDERICK (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:
Last Name:KAROUB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4045 W 13 MILE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-6640
Mailing Address - Country:US
Mailing Address - Phone:248-288-2160
Mailing Address - Fax:248-288-0783
Practice Address - Street 1:4045 W 13 MILE RD
Practice Address - Street 2:SUITE A
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6640
Practice Address - Country:US
Practice Address - Phone:248-288-2160
Practice Address - Fax:248-288-0783
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301059587207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0930630OtherBCBS IND
MI0930630OtherBCN IND
MI1679554562Medicaid
MIM17230001Medicare PIN
MI0930630OtherBCBS IND