Provider Demographics
NPI:1831156413
Name:KARL E MOLIN MD INC
Entity type:Organization
Organization Name:KARL E MOLIN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:EINAR
Authorized Official - Last Name:MOLIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:707-448-8471
Mailing Address - Street 1:1883 VINTAGE LANE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-1433
Mailing Address - Country:US
Mailing Address - Phone:707-864-1612
Mailing Address - Fax:707-448-3169
Practice Address - Street 1:313 KENDAL STREET
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-3920
Practice Address - Country:US
Practice Address - Phone:707-448-8471
Practice Address - Fax:707-448-3169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25390207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A253901Medicaid
CA00A253901Medicaid
A24418Medicare UPIN