Provider Demographics
NPI:1487659066
Name:KREBS, CARLA M (MD)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:M
Last Name:KREBS
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 1:21375 LORAIN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-2122
Mailing Address - Country:US
Mailing Address - Phone:440-333-7346
Mailing Address - Fax:440-333-0273
Practice Address - Street 1:21375 LORAIN RD
Practice Address - Street 2:
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126-2122
Practice Address - Country:US
Practice Address - Phone:440-333-7346
Practice Address - Fax:440-333-0273
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH066584207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH341311807OtherTAX ID
OH000000028180OtherANTHEM
OH0826931Medicaid
OH1487659066OtherNPI NUMBER
OH08-01177OtherUNITED HEALTHCARE
OH1164492591OtherPRACTICE LOCATION LAKEWOOD NPI
OH1275512709OtherMEDICARE PRACTICE NPI
OH180020032OtherRAILROAD MEDICARE
OH0004501425OtherAETNA
OHF66584OtherAPEX
OH0004501425OtherAETNA
OH1164492591OtherPRACTICE LOCATION LAKEWOOD NPI
OH341311807OtherTAX ID