Provider Demographics
NPI:1215914429
Name:UNKENHOLZ, KARL M (MD)
Entity type:Individual
Prefix:DR
First Name:KARL
Middle Name:M
Last Name:UNKENHOLZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 LEROY ST
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-1786
Mailing Address - Country:US
Mailing Address - Phone:315-265-3300
Mailing Address - Fax:315-261-6025
Practice Address - Street 1:50 LEROY ST
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-1786
Practice Address - Country:US
Practice Address - Phone:315-265-3300
Practice Address - Fax:315-261-6025
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD14392207P00000X
CAC53154207P00000X
NY207725-1207P00000X
NMMD2019-0916207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01801445Medicaid
NY686V11OtherBLUECROSS BLUESHIELD
NY92V322Medicare PIN
NY686V11OtherBLUECROSS BLUESHIELD