Healthcare Provider Details

I. General information

NPI: 1376535146
Provider Name (Legal Business Name): DEMETRIOS JOHN KARAMICHOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DEMETRIOS KARAMICHOS MD

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 06/16/2020
Certification Date: 06/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 RIDGE RD STE C
MUNSTER IN
46321-1756
US

IV. Provider business mailing address

931 RIDGE RD STE C
MUNSTER IN
46321-1756
US

V. Phone/Fax

Practice location:
  • Phone: 219-595-3095
  • Fax: 219-881-8776
Mailing address:
  • Phone: 219-595-3095
  • Fax: 219-881-8776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number36093881
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01064242A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: