Provider Demographics
NPI:1780969246
Name:KAROL, ETHAN A (PA)
Entity type:Individual
Prefix:
First Name:ETHAN
Middle Name:A
Last Name:KAROL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:164 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-2728
Mailing Address - Country:US
Mailing Address - Phone:920-405-5384
Mailing Address - Fax:920-405-8005
Practice Address - Street 1:2845 GREENBRIER RD STE 240
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-6519
Practice Address - Country:US
Practice Address - Phone:920-288-8280
Practice Address - Fax:920-288-8285
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI2831363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant