Provider Demographics
NPI:1053324129
Name:KARELIS, THOMAS E JR (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
Last Name:KARELIS
Suffix:JR
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:PO BOX 1297
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41702-1297
Mailing Address - Country:US
Mailing Address - Phone:606-487-0776
Mailing Address - Fax:606-487-0777
Practice Address - Street 1:311 ROY CAMPBELL DR
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-9486
Practice Address - Country:US
Practice Address - Phone:606-487-0776
Practice Address - Fax:606-487-0777
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36880207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00640620OtherRAILROAD MEDICARE
KY64037088Medicaid
KY00216005OtherMEDICARE PTAN
KY36880OtherSTATE LICENCE NUMBER
KYP00693305OtherRAILROAD MEDICARE
KYP00693305OtherRAILROAD MEDICARE
KYBK5930791OtherDEA NUMBER
KY0776322Medicare PIN
KY00712005Medicare PIN
KYP00693305OtherRAILROAD MEDICARE
KY36880OtherSTATE LICENCE NUMBER
KY0969801Medicare ID - Type Unspecified