Provider Demographics
NPI:1003811035
Name:MEYER, KARENMARIE KATHLEEN (MD)
Entity Type:Individual
Prefix:
First Name:KARENMARIE
Middle Name:KATHLEEN
Last Name:MEYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 BITTERSWEET LN
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-4715
Mailing Address - Country:US
Mailing Address - Phone:630-789-8354
Mailing Address - Fax:267-695-6549
Practice Address - Street 1:732 BITTERSWEET LN
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-4715
Practice Address - Country:US
Practice Address - Phone:630-789-8354
Practice Address - Fax:267-695-6549
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036074960207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL399980OtherMEDICARE GROUP PTAN
IL036074960Medicaid
IL907551Medicare ID - Type Unspecified
IL036074960Medicaid