Healthcare Provider Details

I. General information

NPI: 1932298379
Provider Name (Legal Business Name): KARLE MEDICAL GROUP, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 BARCLAY CIR SUITE D
ROCHESTER HILLS MI
48307-4774
US

IV. Provider business mailing address

455 BARCLAY CIR SUITE D
ROCHESTER HILLS MI
48307-4774
US

V. Phone/Fax

Practice location:
  • Phone: 248-852-9596
  • Fax: 248-852-9453
Mailing address:
  • Phone: 248-852-9596
  • Fax: 248-852-9453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101008608
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301084402
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301070013
License Number StateMI

VIII. Authorized Official

Name: PATRICK L KARLE
Title or Position: PRACTICE ADMINISTRATOR
Credential: M.S.
Phone: 248-852-9596