NPIMap

Individual provider Active NPI

Izzat Elias Carouba, M.D

  • Internal Medicine Physician
  • Southfield, MI
National Provider Identifier
1164517769
Registry record updated Mar 29, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
4301079695 Issued in MI
Practice address
29877 Telegraph Rd
Suite 401
Southfield, MI 48034-7661
Phone
(248) 354-0730
Fax
(248) 354-1652
NPI assigned
Oct 3, 2006
Last updated
Mar 29, 2013By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 29, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4301079695 MI Primary

Addresses

Primary practice location

29877 Telegraph Rd
Suite 401
Southfield, MI 48034-7661

Mailing address

3192 Hedgewood LN
Rochester Hills, MI 48309-4509
Phone (248) 230-7896

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20061212000349 MI Practitioner - Internal Medicine 9133128580 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Michigan Premier Geriatrics PLLCGroup PAC ID 4284854704, 6 clinicians

Practice addresses (Care Compare)

2033 Crooks Rd
Royal Oak, MI 48073-4049
Phone (248) 543-2000

27900 Grand River Ave
Suite 220
Farmington Hills, MI 48336-5965
Phone (248) 477-0552

29877 Telegraph Rd
Suite 200
Southfield, MI 48034-7659
Phone (248) 354-0730

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301079695MIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Michigan Healthcare Professionals PC Family Medicine CurrentSince Nov 1, 2011 Accepting new patients
Michigan Premier Geriatrics PLLC Internal Medicine CurrentSince Sep 1, 2014 Accepting new patients
Michigan Healthcare Professionals PC CurrentSince Nov 1, 2011 Accepting new patients
Associated General Practice Network PLLC Internal Medicine Past Accepting new patients
Woodward Hills Health and Rehabilitation Center, LLC Past Accepting new patients
William Beaumont Hospital Past Accepting new patients
William Beaumont Hospital Past Accepting new patients
Anchor Senior Medical Services PLLC Internal Medicine Past Accepting new patients
Select Specialty Hospital - Macomb County Inc Past Accepting new patients

Locations

27900 Grand River Ave
Ste 220
Farmington Hills, MI 48336
Phone (248) 477-0552

29992 Northwestern Hwy
Ste C
Farmington Hills, MI 48334
Phone (248) 851-1430

32255 Northwestern Hwy
Ste 100
Farmington Hills, MI 48334
Phone (248) 945-0000

44405 Woodward Ave
Fl 8
Pontiac, MI 48341
Phone (248) 452-5200

1221 Pine Grove Ave
Port Huron, MI 48060
Phone (810) 989-3300

2033 Crooks Rd
Royal Oak, MI 48073
Phone (248) 543-2000

28625 Northwestern Hwy
Ste 213
Southfield, MI 48034
Phone (248) 354-9666

29877 Telegraph Rd
Ste 2
Southfield, MI 48034

29877 Telegraph Rd
Ste 200
Southfield, MI 48034
Phone (248) 354-0730

29877 Telegraph Rd
Ste 401
Southfield, MI 48034
Phone (248) 354-0730

6950 Farmington Rd
West Bloomfield, MI 48322
Phone (248) 478-5645

Interoperability endpoints

  • Direct secure messaging: izzat.carouba.1@11987.direct.athenahealth.com

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 12

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1364515200000",
    "number": "1164517769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3192 HEDGEWOOD LN",
            "city": "ROCHESTER HILLS",
            "state": "MI",
            "postal_code": "483094509",
            "telephone_number": "248-230-7896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29877 TELEGRAPH RD",
            "address_2": "SUITE 401",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480347661",
            "telephone_number": "248-354-0730",
            "fax_number": "248-354-1652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAROUBA",
        "first_name": "IZZAT",
        "middle_name": "ELIAS",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2013-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301079695",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southfield, MI

Sources for this page

Verify at the official NPI Registry.