MEDICARE: DR. KARL E STUDTMANN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	MD31461	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477545283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KARL E STUDTMANN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 400
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38302-0400
Country	:	US
Telephone Number	:	731-423-8697
Fax Number	:	731-425-5783

Provider Business Practice Location Address
First Line	:	145 INNOVATION DR
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-3019
Country	:	US
Telephone Number	:	731-422-0213
Fax Number	:	731-422-0297

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	08/15/2024

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