Basic Information
| Provider Information | |||||||||
| NPI: | 1568450666 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KARLOVSKY | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 CROSSROADS DR STE 306 | ||||||||
| Address2: | |||||||||
| City: | OWINGS MILLS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211175437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 0262221900 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2530 E SOUTHERN AVE | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852045411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808344188 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2005 | ||||||||
| LastUpdateDate: | 07/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 33566 | AZ | N | Allopathic & Osteopathic Physicians | Urology | 2088F0040X | 33566 | AZ | Y | Allopathic & Osteopathic Physicians | Urology | Female Pelvic Medicine and Reconstructive Surgery | 174400000X | 33566 | AZ | N | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 931833 | 05 | AZ | MEDICAID |