Provider Demographics
NPI:1013024546
Name:KARLS, CHARLENE M (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARLENE
Middle Name:M
Last Name:KARLS
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 1:700 N LAKE AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:TWIN LAKES
Mailing Address - State:WI
Mailing Address - Zip Code:53181-9436
Mailing Address - Country:US
Mailing Address - Phone:262-877-2124
Mailing Address - Fax:262-877-9833
Practice Address - Street 1:700 N LAKE AVE STE 102
Practice Address - Street 2:
Practice Address - City:TWIN LAKES
Practice Address - State:WI
Practice Address - Zip Code:53181-9436
Practice Address - Country:US
Practice Address - Phone:262-877-2124
Practice Address - Fax:262-877-9833
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI31455207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30048000Medicaid
BK2342830OtherDEA NUMBER
WI30048000Medicaid
BK2342830OtherDEA NUMBER