Provider Demographics
NPI:1922051457
Name:KARUNAKARAN, K P (MD)
Entity Type:Individual
Prefix:
First Name:K
Middle Name:P
Last Name:KARUNAKARAN
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 1:5685 GRATIOT RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48638-6042
Mailing Address - Country:US
Mailing Address - Phone:989-497-5278
Mailing Address - Fax:989-497-8750
Practice Address - Street 1:5685 GRATIOT RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48638-6042
Practice Address - Country:US
Practice Address - Phone:989-497-5278
Practice Address - Fax:989-497-8750
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301039664208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2097705Medicaid
MI2097705Medicaid
0738685Medicare ID - Type Unspecified