Provider Demographics
NPI:1609868710
Name:KAROLYI, TRACY A (DO)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:A
Last Name:KAROLYI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 BRIGHAM DR STE 240
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-7124
Mailing Address - Country:US
Mailing Address - Phone:419-872-7700
Mailing Address - Fax:419-874-0196
Practice Address - Street 1:1620 BRIGHAM DR STE 240
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-7124
Practice Address - Country:US
Practice Address - Phone:419-872-7700
Practice Address - Fax:419-874-0196
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006285208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH03005OtherPHC
OH2095218Medicaid
OHBK4678530OtherMEDICARE
OH000000141248OtherANTHEM
OH12-01781OtherUHC
OH2311207OtherAETNA
OH03005OtherPHC