Provider Demographics
NPI:1033102736
Name:KARAMITSOS & WILTCHIK, A MEDICAL CORP
Entity Type:Organization
Organization Name:KARAMITSOS & WILTCHIK, A MEDICAL CORP
Other - Org Name:CENTRAL COAST WOMEN'S HEALTH, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:A
Authorized Official - Last Name:KARAMITSOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-347-2100
Mailing Address - Street 1:300 S STRATFORD AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-5907
Mailing Address - Country:US
Mailing Address - Phone:805-347-2100
Mailing Address - Fax:805-347-2114
Practice Address - Street 1:300 S STRATFORD AVE
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5907
Practice Address - Country:US
Practice Address - Phone:805-347-2100
Practice Address - Fax:805-347-2114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-26
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC2666948207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0099400Medicaid
ZZZ64160ZOtherBLUE SHIELD OF CA
CADC8854Medicare PIN
CAW18368Medicare PIN