Healthcare Provider Details

I. General information

NPI: 1518861665
Provider Name (Legal Business Name): KARMINE HOWARD-HAIRSTON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5394 W OUTER DR
DETROIT MI
48235-1452
US

IV. Provider business mailing address

5394 W OUTER DR
DETROIT MI
48235-1452
US

V. Phone/Fax

Practice location:
  • Phone: 810-333-6222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174200000X
TaxonomyMeals Provider
License NumberH636461139025
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: