Provider Demographics
NPI:1922493733
Name:KARASOV, MICAH (DO)
Entity type:Individual
Prefix:
First Name:MICAH
Middle Name:
Last Name:KARASOV
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 SNELLING AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-1525
Mailing Address - Country:US
Mailing Address - Phone:651-698-0386
Mailing Address - Fax:866-314-4031
Practice Address - Street 1:565 SNELLING AVE S
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-1525
Practice Address - Country:US
Practice Address - Phone:651-698-0386
Practice Address - Fax:651-379-0464
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN68080207K00000X
LA308488208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology