Provider Demographics
NPI:1194797654
Name:KARADIMAS, LEONARD T (DO)
Entity type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:T
Last Name:KARADIMAS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1231 PINE GROVE AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3500
Mailing Address - Country:US
Mailing Address - Phone:810-985-4300
Mailing Address - Fax:810-985-9320
Practice Address - Street 1:1231 PINE GROVE AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3500
Practice Address - Country:US
Practice Address - Phone:810-985-4300
Practice Address - Fax:810-985-9320
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MILK012026207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3446462Medicaid
MI3446462Medicaid