Provider Demographics
NPI:1104933043
Name:HARNISH, KARL (DO)
Entity type:Individual
Prefix:
First Name:KARL
Middle Name:
Last Name:HARNISH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 BRIARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-1302
Mailing Address - Country:US
Mailing Address - Phone:740-593-8920
Mailing Address - Fax:
Practice Address - Street 1:39 BRIARWOOD DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-1302
Practice Address - Country:US
Practice Address - Phone:740-593-8920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34003814H207P00000X
CA20A 5228207P00000X
ME1139207P00000X
FLOS-10241207P00000X
WI55011-21207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0586790Medicaid
FL000392700Medicaid
FL03795OtherBLUE SHIELD
FL03795OtherBLUE SHIELD
OH0563457Medicare PIN
OHC02902Medicare UPIN
OH0586790Medicaid
FLBI614YMedicare PIN