Provider Demographics
NPI:1790004232
Name:KARLOVIC, MATTHEW WILSON (LPN)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:WILSON
Last Name:KARLOVIC
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 E BROAD ST
Mailing Address - Street 2:11TH FLOOR
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-3430
Mailing Address - Country:US
Mailing Address - Phone:604-466-6583
Mailing Address - Fax:614-644-5331
Practice Address - Street 1:1344 5TH AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1703
Practice Address - Country:US
Practice Address - Phone:330-742-2595
Practice Address - Fax:330-742-2598
Is Sole Proprietor?:No
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN120030MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse