Provider Demographics
NPI:1093984197
Name:KAREN M. ACKERMAN, D.P.M., P.A.
Entity Type:Organization
Organization Name:KAREN M. ACKERMAN, D.P.M., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ACKERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:620-225-7829
Mailing Address - Street 1:2300 N 14TH AVE STE 100A
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-2367
Mailing Address - Country:US
Mailing Address - Phone:620-225-7829
Mailing Address - Fax:620-225-4827
Practice Address - Street 1:2300 N 14TH AVE STE 100A
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-2367
Practice Address - Country:US
Practice Address - Phone:620-225-7829
Practice Address - Fax:620-225-4827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12-00286213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
480026013OtherRAILROAD MEDICARE
KS114024OtherBLUECROSS BLUESHIELD
KS6207910001Medicare NSC
480026013OtherRAILROAD MEDICARE
KS114024OtherBLUECROSS BLUESHIELD