Provider Demographics
NPI:1851494439
Name:JAMES KARAGON PC
Entity Type:Organization
Organization Name:JAMES KARAGON PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:KARAGON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:313-962-4075
Mailing Address - Street 1:PO BOX 441675
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48244-1675
Mailing Address - Country:US
Mailing Address - Phone:313-962-4075
Mailing Address - Fax:
Practice Address - Street 1:555 BRUSH ST
Practice Address - Street 2:2406
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226-4348
Practice Address - Country:US
Practice Address - Phone:313-962-4075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010078761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
R67832Medicare UPIN
0P21940Medicare ID - Type Unspecified