Provider Demographics
NPI:1770875437
Name:DEHA KARAOGLAN
Entity type:Organization
Organization Name:DEHA KARAOGLAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEHA
Authorized Official - Middle Name:K
Authorized Official - Last Name:KARAOGLAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:707-526-4777
Mailing Address - Street 1:1041 4TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-4329
Mailing Address - Country:US
Mailing Address - Phone:707-526-4777
Mailing Address - Fax:707-526-8809
Practice Address - Street 1:1041 4TH ST STE B
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4329
Practice Address - Country:US
Practice Address - Phone:707-526-4777
Practice Address - Fax:707-526-8809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4703213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6505510001Medicare NSC