Provider Demographics
NPI:1376533422
Name:KARLOCK, CATHERINE A (DPM)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:A
Last Name:KARLOCK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 SANDSTONE LN
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-7610
Mailing Address - Country:US
Mailing Address - Phone:330-792-6519
Mailing Address - Fax:330-792-9911
Practice Address - Street 1:1300 S CANFIELD NILES RD
Practice Address - Street 2:SUITE 1
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-4081
Practice Address - Country:US
Practice Address - Phone:330-792-6519
Practice Address - Fax:330-792-9911
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002853213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000139308OtherANTHEMBCBS
PA0077464200001Medicaid
OH0103453Medicaid
OH0787551Medicare PIN
OH480024538Medicare PIN
OHU50609Medicare UPIN
PA0077464200001Medicaid