Provider Demographics
NPI:1275535163
Name:KARNITIS, SUE A (MD)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:A
Last Name:KARNITIS
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 1:825 N MAIN STREET
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-1503
Mailing Address - Country:US
Mailing Address - Phone:937-762-5500
Mailing Address - Fax:937-762-5099
Practice Address - Street 1:825 N MAIN STREET
Practice Address - Street 2:SUITE 210
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-1503
Practice Address - Country:US
Practice Address - Phone:937-762-5500
Practice Address - Fax:937-762-5099
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35062496208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000141221OtherANTHEM
OH01930OtherPARAMOUNT
OH0637763OtherAETNA
OH0863927Medicaid
OH370012700OtherRRMC
OH12-01219OtherUHC
OHKO790972OtherMEDICARE
OH0863927Medicaid
OH0863927Medicaid