Basic Information
| Provider Information | |||||||||
| NPI: | 1609868710 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAROLYI | ||||||||
| FirstName: | TRACY | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1601 BRIGHAM DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | PERRYSBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435517114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198727700 | ||||||||
| FaxNumber: | 4198740196 | ||||||||
| Practice Location | |||||||||
| Address1: | 1601 BRIGHAM DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | PERRYSBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435517114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198727700 | ||||||||
| FaxNumber: | 4198740196 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2005 | ||||||||
| LastUpdateDate: | 05/01/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 34006285 | OH | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | BK4678530 | 01 | OH | MEDICARE | OTHER | 03005 | 01 | OH | PHC | OTHER | 2095218 | 05 | OH | MEDICAID | 12-01781 | 01 | OH | UHC | OTHER | 2311207 | 01 | OH | AETNA | OTHER | 000000141248 | 01 | OH | ANTHEM | OTHER |