MEDICARE: CARL M KAROUB MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	4301042923	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0636739	OTHER	MI	MEDICARE PLUS BLUE PPO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	0636739	OTHER	MI	BCBS TRADITIONAL

General Provider Information

NPI Number	:	1063494706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARL M KAROUB MD

Provider Business Mailing Address
First Line	:	4045 W 13 MILE RD
Second Line	:	SUITE A
City	:	ROYAL OAK
State	:	MI
Zip	:	48073-6640
Country	:	US
Telephone Number	:	248-288-2160
Fax Number	:	248-288-0783

Provider Business Practice Location Address
First Line	:	4045 W 13 MILE RD
Second Line	:	SUITE A
City	:	ROYAL OAK
State	:	MI
Zip	:	48073-6640
Country	:	US
Telephone Number	:	248-288-2160
Fax Number	:	248-288-0783

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	08/22/2019

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