=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811778533
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KARAS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2023
-----------------------------------------------------
Last Update Date | 11/06/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7201 OHMS LN STE 100
-----------------------------------------------------
City | EDINA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55439-2155
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-726-6694
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 160 SORRENTO DR
-----------------------------------------------------
City | HOLLAND
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49423-6618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-533-5743
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COMPLIANCE OFFICER
-----------------------------------------------------
Name | LAURA TERPSMA
-----------------------------------------------------
Credential | JD
-----------------------------------------------------
Telephone | 248-533-5743
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------