Healthcare Provider Details

I. General information

NPI: 1225072721
Provider Name (Legal Business Name): MACK KARNES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 E LAYTON AVE
ST FRANCIS WI
53235-6053
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 414-744-6589
  • Fax: 414-747-8848
Mailing address:
  • Phone: 800-326-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number21496
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: