Provider Demographics
NPI:1255485678
Name:DUBERSTEIN, KAREN LIN (DO)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LIN
Last Name:DUBERSTEIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:LIN
Other - Last Name:BARTLETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:ELLINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63638-0157
Mailing Address - Country:US
Mailing Address - Phone:573-663-2313
Mailing Address - Fax:573-663-2322
Practice Address - Street 1:301 NORTH HIGHWAY 21
Practice Address - Street 2:
Practice Address - City:PILOT KNOB
Practice Address - State:MO
Practice Address - Zip Code:63663
Practice Address - Country:US
Practice Address - Phone:573-546-2000
Practice Address - Fax:573-546-3006
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006000672207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO206888208Medicaid
MO206888208Medicaid
A02758Medicare UPIN