MEDICARE: ALFRED KARNICKI JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	036040456	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	04900467	OTHER	IL	BCBSIL

General Provider Information

NPI Number	:	1932228012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALFRED KARNICKI JR. MD

Provider Business Mailing Address
First Line	:	476 BRIAR LN
Second Line	:
City	:	LAKE FOREST
State	:	IL
Zip	:	60045-3122
Country	:	US
Telephone Number	:	847-295-2050
Fax Number	:

Provider Business Practice Location Address
First Line	:	476 BRIAR LN
Second Line	:
City	:	LAKE FOREST
State	:	IL
Zip	:	60045-3122
Country	:	US
Telephone Number	:	847-295-2050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	11/13/2009

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