Basic Information
| Provider Information | |||||||||
| NPI: | 1679554562 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAROUB | ||||||||
| FirstName: | FREDERICK | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 4045 W 13 MILE RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | ROYAL OAK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480736640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2482882160 | ||||||||
| FaxNumber: | 2482880783 | ||||||||
| Practice Location | |||||||||
| Address1: | 4045 W 13 MILE RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | ROYAL OAK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480736640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2482882160 | ||||||||
| FaxNumber: | 2482880783 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2005 | ||||||||
| LastUpdateDate: | 03/08/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 03/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301059587 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0930630 | 01 | MI | BCBS IND | OTHER | 0930630 | 01 | MI | BCN IND | OTHER | 1679554562 | 05 | MI | MEDICAID |