Provider Demographics
NPI:1588869598
Name:TRUJILLO, KARIN (MD)
Entity type:Individual
Prefix:
First Name:KARIN
Middle Name:
Last Name:TRUJILLO
Suffix:
Gender:F
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:PO BOX 3755
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-0755
Mailing Address - Country:US
Mailing Address - Phone:402-354-5451
Mailing Address - Fax:402-354-2155
Practice Address - Street 1:1120 N 103RD PLZ STE 100
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-1119
Practice Address - Country:US
Practice Address - Phone:402-354-0400
Practice Address - Fax:402-354-0425
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY240838208G00000X
NE24790208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY240838OtherLICENSE