Healthcare Provider Details

I. General information

NPI: 1740419019
Provider Name (Legal Business Name): THOMAS JAMES KARRAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2009
Last Update Date: 07/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 S TURTLE BAY
ELKHART LAKE WI
53020-1985
US

IV. Provider business mailing address

212 S TURTLE BAY
ELKHART LAKE WI
53020-1985
US

V. Phone/Fax

Practice location:
  • Phone: 619-992-0007
  • Fax:
Mailing address:
  • Phone: 619-992-0007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number18611-020
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberGFE18632
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: