Provider Demographics
NPI:1003847948
Name:SPODAREK, KAREN L (DO)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:SPODAREK
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:PO BOX 2363
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-2363
Mailing Address - Country:US
Mailing Address - Phone:843-724-2154
Mailing Address - Fax:843-805-6277
Practice Address - Street 1:316 CALHOUN ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-1113
Practice Address - Country:US
Practice Address - Phone:843-724-2154
Practice Address - Fax:843-805-6277
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25422085R0202X
OK48702085R0202X
SCDO13742085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200294710AOtherOSU MEDICAID
KY64025422Medicaid
OK200294710BMedicaid
OKOKA101486Medicare PIN
KYF86933Medicare UPIN
KY0639914Medicare ID - Type Unspecified
KY0639814Medicare ID - Type Unspecified
KY64025422Medicaid