Provider Demographics
NPI:1922493733
Name:KARASOV, MICAH (DO)
Entity Type:Individual
Prefix:
First Name:MICAH
Middle Name:
Last Name:KARASOV
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12450 WAYZATA BLVD STE 215
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-1927
Mailing Address - Country:US
Mailing Address - Phone:952-546-6866
Mailing Address - Fax:952-512-0038
Practice Address - Street 1:1430 TULANE AVE # SL-37
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2632
Practice Address - Country:US
Practice Address - Phone:504-988-5458
Practice Address - Fax:504-988-6808
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-30
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN68080207K00000X
LA308488208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology