Provider Demographics
NPI:1124089339
Name:KARADEEMA, KEVIN M (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:M
Last Name:KARADEEMA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22908 WICK RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-3589
Mailing Address - Country:US
Mailing Address - Phone:313-295-7760
Mailing Address - Fax:
Practice Address - Street 1:22908 WICK RD
Practice Address - Street 2:SUITE B
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-3589
Practice Address - Country:US
Practice Address - Phone:313-295-7760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4356111N00000X
MIKKOO5272111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2736548Medicaid
MI95OH25311OtherPROVIDER ID
MIU35737Medicare UPIN
MI95OH25311OtherPROVIDER ID