Provider Demographics
NPI:1205836475
Name:KARNIK, NITIN M (MD)
Entity Type:Individual
Prefix:DR
First Name:NITIN
Middle Name:M
Last Name:KARNIK
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 1:7501 92ND AVENUE CT SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-3973
Mailing Address - Country:US
Mailing Address - Phone:253-588-0058
Mailing Address - Fax:253-589-4862
Practice Address - Street 1:HEARTWOOD EXTENDED HEALTHCARE
Practice Address - Street 2:1649 EAST 72ND
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98404
Practice Address - Country:US
Practice Address - Phone:253-472-9027
Practice Address - Fax:253-474-9522
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000224722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
260030328OtherRAILROAD MEDICARE
WA1098128Medicaid
WA532764001OtherGROUP HEALTH
260030328OtherRAILROAD MEDICARE
G115000873Medicare ID - Type Unspecified