Provider Demographics
NPI:1245224161
Name:MAGOWAN, KAREN C (PA)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:C
Last Name:MAGOWAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47601 GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-1233
Mailing Address - Country:US
Mailing Address - Phone:248-465-3157
Mailing Address - Fax:248-465-3784
Practice Address - Street 1:47601 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1233
Practice Address - Country:US
Practice Address - Phone:248-465-3157
Practice Address - Fax:248-465-3784
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005688363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
200107998OtherAETNA PPO
200107998OtherAETNA HMO
P00064195Medicare PIN
200107998OtherAETNA PPO
P86716Medicare UPIN
710M252FMedicare PIN