Healthcare Provider Details

I. General information

NPI: 1205836475
Provider Name (Legal Business Name): NITIN M KARNIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 05/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HEARTWOOD EXTENDED HEALTHCARE 1649 EAST 72ND
TACOMA WA
98404
US

IV. Provider business mailing address

7501 92ND AVENUE CT SW
LAKEWOOD WA
98498-3973
US

V. Phone/Fax

Practice location:
  • Phone: 253-472-9027
  • Fax: 253-474-9522
Mailing address:
  • Phone: 253-588-0058
  • Fax: 253-589-4862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD00022472
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: