Provider Demographics
NPI:1225035884
Name:MERCOLA, KAREN ELAINE (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ELAINE
Last Name:MERCOLA
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 1:9735 WILSHIRE BLVD
Mailing Address - Street 2:STE 400
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-2103
Mailing Address - Country:US
Mailing Address - Phone:310-859-4948
Mailing Address - Fax:310-391-2660
Practice Address - Street 1:9735 WILSHIRE BLVD
Practice Address - Street 2:STE 400
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-2103
Practice Address - Country:US
Practice Address - Phone:310-859-4948
Practice Address - Fax:310-391-2660
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30394207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G303940Medicaid
A44406Medicare UPIN
CAG30394Medicare ID - Type Unspecified