Provider Demographics
NPI:1548263163
Name:KARAMLOU, KASRA (MD)
Entity type:Individual
Prefix:
First Name:KASRA
Middle Name:
Last Name:KARAMLOU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 QUARRY LAKES DR
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-8635
Mailing Address - Country:US
Mailing Address - Phone:419-626-9090
Mailing Address - Fax:419-626-6319
Practice Address - Street 1:417 QUARRY LAKES DR
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-8635
Practice Address - Country:US
Practice Address - Phone:419-626-9090
Practice Address - Fax:419-626-6319
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD22283207RH0003X
CAC55442207RH0003X
AZ52718207RH0003X
OH35-135237207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ163654Medicaid
OR288281Medicaid
ORCV0082OtherRR MEDICARE GROUP NUMBER
H-25087Medicare UPIN
ORCV0082OtherRR MEDICARE GROUP NUMBER
114418Medicare ID - Type Unspecified