Provider Demographics
NPI:1902829930
Name:CARALIS, JAMES PETER (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:PETER
Last Name:CARALIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:44555 WOODWARD AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-5031
Mailing Address - Country:US
Mailing Address - Phone:248-858-3939
Mailing Address - Fax:248-858-3844
Practice Address - Street 1:44555 WOODWARD AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5031
Practice Address - Country:US
Practice Address - Phone:248-858-3939
Practice Address - Fax:248-858-3844
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101007741208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4190333Medicaid
MI4190333Medicaid
OM93490Medicare ID - Type Unspecified