Basic Information
| Provider Information | |||||||||
| NPI: | 1083615058 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KAARIAINEN | ||||||||
| FirstName: | ISMO | ||||||||
| MiddleName: | MIKAEL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 810 FAIRGROVE CHURCH RD | ||||||||
| Address2: | |||||||||
| City: | HICKORY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283263809 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 810 FAIRGROVE CHURCH RD | ||||||||
| Address2: | |||||||||
| City: | HICKORY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283263809 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2005 | ||||||||
| LastUpdateDate: | 08/29/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 200101075 | NC | N | Other Service Providers | Specialist | 208M00000X | 200101075 | NC | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 200101075 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 14262 | 01 | NCBC | OTHER | 89129PF | 05 | NC | MEDICAID | 129PF | 01 | NC | BCBS - CVMC | OTHER |