Healthcare Provider Details

I. General information

NPI: 1245313535
Provider Name (Legal Business Name): MICKEY M KARRAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7759 UNIVERSITY DRIVE SUITE G
WEST CHESTER OH
45069
US

IV. Provider business mailing address

237 WILLIAM HOWARD TAFT, PHYS. DIV. 2ND FL, CBO2-3, ATTN: CREDENTIALING
CINCINNATI OH
45219-2906
US

V. Phone/Fax

Practice location:
  • Phone: 513-463-2500
  • Fax: 513-463-2510
Mailing address:
  • Phone: 513-263-8571
  • Fax: 513-366-4480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35.053449
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2088F0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Urology) Physician
License Number23528
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code2088F0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Urology) Physician
License Number35.053449
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: