Basic Information
| Provider Information | |||||||||
| NPI: | 1982837415 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KARANAM | ||||||||
| FirstName: | KARTHIK | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 E CHEVES ST | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295062708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436696694 | ||||||||
| FaxNumber: | 8436692500 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 E CHEVES ST | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295062708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436696694 | ||||||||
| FaxNumber: | 8436692500 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2009 | ||||||||
| LastUpdateDate: | 09/14/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MT192193 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 01069628A | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RN0300X | MD37981 | SC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 201027410 | 05 | IN | MEDICAID |