Provider Demographics
NPI:1285638734
Name:KEMP-GLOCK, KAREN M (DO)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:KEMP-GLOCK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12339 STRATFORD DR
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-8148
Mailing Address - Country:US
Mailing Address - Phone:515-263-9107
Mailing Address - Fax:515-265-9888
Practice Address - Street 1:12339 STRATFORD DR
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-8148
Practice Address - Country:US
Practice Address - Phone:515-263-9107
Practice Address - Fax:515-265-9888
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3249207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0192682Medicaid
IA06751OtherWELLMARK BLUE SHIELD
IA09743OtherWELLMARK, ANKENY OFFICE
IA0192682Medicaid
IA09743OtherWELLMARK, ANKENY OFFICE