Provider Demographics
NPI:1699938456
Name:KARIMOU, ISSIFI (MD)
Entity type:Individual
Prefix:
First Name:ISSIFI
Middle Name:
Last Name:KARIMOU
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 1:1301 E P ST
Mailing Address - Street 2:APT D
Mailing Address - City:TORRINGTON
Mailing Address - State:WY
Mailing Address - Zip Code:82240-3539
Mailing Address - Country:US
Mailing Address - Phone:307-575-4018
Mailing Address - Fax:
Practice Address - Street 1:625 ALBANY AVE
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:WY
Practice Address - Zip Code:82240-1530
Practice Address - Country:US
Practice Address - Phone:307-534-7058
Practice Address - Fax:307-532-5617
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5794207Q00000X
WY8745A282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW24242Medicare PIN