Basic Information
| Provider Information | |||||||||
| NPI: | 1164517769 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAROUBA | ||||||||
| FirstName: | IZZAT | ||||||||
| MiddleName: | ELIAS | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3192 HEDGEWOOD LN | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483094509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2482307896 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 29877 TELEGRAPH RD | ||||||||
| Address2: | SUITE 401 | ||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480347661 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483540730 | ||||||||
| FaxNumber: | 2483541652 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 03/29/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301079695 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.