Provider Demographics
NPI:1134114697
Name:SANDERS, KAREN ARNELL (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:ARNELL
Last Name:SANDERS
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 1:375 N WALL ST
Mailing Address - Street 2:STE P410
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-3483
Mailing Address - Country:US
Mailing Address - Phone:815-932-7474
Mailing Address - Fax:815-937-8206
Practice Address - Street 1:375 N WALL ST
Practice Address - Street 2:STE P410
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3483
Practice Address - Country:US
Practice Address - Phone:815-932-7474
Practice Address - Fax:815-937-8206
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036097761207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036097761Medicaid
G97480Medicare UPIN
IL036097761Medicaid