Provider Demographics
NPI:1932298379
Name:KARLE MEDICAL GROUP, P.C.
Entity Type:Organization
Organization Name:KARLE MEDICAL GROUP, P.C.
Other - Org Name:KARLE MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:L
Authorized Official - Last Name:KARLE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:248-852-9596
Mailing Address - Street 1:455 BARCLAY CIR
Mailing Address - Street 2:SUITE D
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-4774
Mailing Address - Country:US
Mailing Address - Phone:248-852-9596
Mailing Address - Fax:248-852-9453
Practice Address - Street 1:455 BARCLAY CIR
Practice Address - Street 2:SUITE D
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-4774
Practice Address - Country:US
Practice Address - Phone:248-852-9596
Practice Address - Fax:248-852-9453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008608207Q00000X
MI4301084402207R00000X
MI4301070013207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00238057OtherRAILROAD MEDICARE
MI080F326810OtherBLUE CROSS BLUE SHIELD MI
MI0P15420Medicare PIN