Healthcare Provider Details

I. General information

NPI: 1700807260
Provider Name (Legal Business Name): RICHARD D KAREM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 HOSPITAL WAY
POCATELLO ID
83201-5175
US

IV. Provider business mailing address

777 HOSPITAL WAY
POCATELLO ID
83201-5175
US

V. Phone/Fax

Practice location:
  • Phone: 208-239-2722
  • Fax: 208-239-3759
Mailing address:
  • Phone: 208-239-2722
  • Fax: 208-239-3759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberG048704
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberM12845
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD60682113
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: