Provider Demographics
NPI:1235659178
Name:ROSS, KARNALDO
Entity Type:Individual
Prefix:
First Name:KARNALDO
Middle Name:
Last Name:ROSS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:SINCERE
Other - Middle Name:MED
Other - Last Name:SERVICE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4150 BUNKUM RD
Mailing Address - Street 2:
Mailing Address - City:EAST SAINT LOUIS
Mailing Address - State:IL
Mailing Address - Zip Code:62204-3050
Mailing Address - Country:US
Mailing Address - Phone:618-514-9250
Mailing Address - Fax:
Practice Address - Street 1:4150 BUNKUM RD
Practice Address - Street 2:
Practice Address - City:EAST SAINT LOUIS
Practice Address - State:IL
Practice Address - Zip Code:62204-3050
Practice Address - Country:US
Practice Address - Phone:618-514-9250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle