Healthcare Provider Details

I. General information

NPI: 1306294582
Provider Name (Legal Business Name): RACHEL ANN KARACSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2016
Last Update Date: 09/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 JOHN ROLFE DR
MONROE MI
48162-3314
US

IV. Provider business mailing address

3942 6TH ST
WYANDOTTE MI
48192-6809
US

V. Phone/Fax

Practice location:
  • Phone: 734-301-9539
  • Fax:
Mailing address:
  • Phone: 734-301-9539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberK625730067182
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: