Healthcare Provider Details

I. General information

NPI: 1639728405
Provider Name (Legal Business Name): KARIM KABBANI LLP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2019
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 W LAKE LANSING RD STE 400
EAST LANSING MI
48823-8528
US

IV. Provider business mailing address

612 W LAKE LANSING RD STE 400
EAST LANSING MI
48823-8528
US

V. Phone/Fax

Practice location:
  • Phone: 517-337-6545
  • Fax: 517-337-3010
Mailing address:
  • Phone: 517-337-6545
  • Fax: 517-337-3010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6361007649
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: