Provider Demographics
NPI:1982622338
Name:DEHAAN, KARL (MD)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:
Last Name:DEHAAN
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 1:1 INFINITY CORPORATE CENTRE DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-5369
Mailing Address - Country:US
Mailing Address - Phone:216-663-7064
Mailing Address - Fax:216-663-8286
Practice Address - Street 1:1 INFINITY CORPORATE CENTRE DR
Practice Address - Street 2:SUITE 130
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-5369
Practice Address - Country:US
Practice Address - Phone:216-663-7064
Practice Address - Fax:216-663-8286
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAD6714732207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0366803Medicaid
OH$$$$$$$$$00OtherBWC
OHA77543Medicare UPIN
OH0366803Medicaid