Provider Demographics
NPI:1275510216
Name:AARESTAD, KAREN ELLEN (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ELLEN
Last Name:AARESTAD
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 1:406 W WASHINGTON ST STE 5
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-2987
Mailing Address - Country:US
Mailing Address - Phone:951-533-8668
Mailing Address - Fax:
Practice Address - Street 1:722 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-2912
Practice Address - Country:US
Practice Address - Phone:218-855-1115
Practice Address - Fax:218-855-1183
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG68248207R00000X
ND5588207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ318872OtherGROUP MEDICARE
E63949Medicare UPIN
00G84280Medicare ID - Type Unspecified