Provider Demographics
NPI:1679631188
Name:KARNEZIS, TOM A (MD)
Entity Type:Individual
Prefix:
First Name:TOM
Middle Name:A
Last Name:KARNEZIS
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 1:8901 GOLF RD
Mailing Address - Street 2:STE 203
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-4028
Mailing Address - Country:US
Mailing Address - Phone:847-439-1200
Mailing Address - Fax:847-439-1212
Practice Address - Street 1:8901 GOLF RD
Practice Address - Street 2:STE 203
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-4028
Practice Address - Country:US
Practice Address - Phone:847-439-1200
Practice Address - Fax:847-439-1212
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036085306207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036085306Medicaid
4985640001OtherDMERC
1633094OtherBCBS
P00012437OtherRRMC
204519Medicare ID - Type Unspecified
IL036085306Medicaid