Basic Information
Provider Information | |||||||||
NPI: | 1568896967 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KARKORIAN | ||||||||
FirstName: | PAUL | ||||||||
MiddleName: | NORK | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1010 MAIN ST S | ||||||||
Address2: |   | ||||||||
City: | MC KEE | ||||||||
State: | KY | ||||||||
PostalCode: | 404477089 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8596267700 | ||||||||
FaxNumber: | 8596267890 | ||||||||
Practice Location | |||||||||
Address1: | 401 HIGHLAND PARK DR | ||||||||
Address2: |   | ||||||||
City: | RICHMOND | ||||||||
State: | KY | ||||||||
PostalCode: | 404753839 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8596267700 | ||||||||
FaxNumber: | 8596267890 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/21/2013 | ||||||||
LastUpdateDate: | 08/04/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X |   |   | N |   | Student, Health Care | Student in an Organized Health Care Education/Training Program |   | 207R00000X | 49051 | KY | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
No ID Information.