Basic Information
| Provider Information | |||||||||
| NPI: | 1912078577 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VOLKE | ||||||||
| FirstName: | KARLA | ||||||||
| MiddleName: | NO MIDDLE INITIAL | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | VOLKE-WOOD | ||||||||
| OtherFirstName: | KARLA | ||||||||
| OtherMiddleName: | NO MIDDLE INITIAL | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | D.O. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 832 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ORRVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446672208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306844760 | ||||||||
| FaxNumber: | 3306832130 | ||||||||
| Practice Location | |||||||||
| Address1: | 832 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ORRVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446672208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306844760 | ||||||||
| FaxNumber: | 3306832130 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 34-007839 | OH | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | P00232320 | 01 | OH | MEDICARE RAILROAD | OTHER | 2362312 | 05 | OH | MEDICAID |