Healthcare Provider Details

I. General information

NPI: 1386816544
Provider Name (Legal Business Name): LORAN E KARLOSKY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2008
Last Update Date: 04/03/2022
Certification Date: 04/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 SUNCREST DR
JACKSON TN
38305-1782
US

IV. Provider business mailing address

28 SUNCREST DR
JACKSON TN
38305-1782
US

V. Phone/Fax

Practice location:
  • Phone: 859-494-2846
  • Fax:
Mailing address:
  • Phone: 859-494-2846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberTN45903
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberTN45903
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: