Healthcare Provider Details

I. General information

NPI: 1043254741
Provider Name (Legal Business Name): RICHARD C KARN P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 06/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 PROVIDENT DRIVE STE A
WARSAW IN
46580
US

IV. Provider business mailing address

1500 PROVIDENT DRIVE STE A
WARSAW IN
46580
US

V. Phone/Fax

Practice location:
  • Phone: 574-372-7637
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number100002495A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: