Provider Demographics
NPI:1326016015
Name:MARTENS, KAREN ANN (PA)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ANN
Last Name:MARTENS
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 1:4777 E OUTER DRIVE
Mailing Address - Street 2:ADVANTAGE FAMILY HEALTH
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48234
Mailing Address - Country:US
Mailing Address - Phone:313-369-1960
Mailing Address - Fax:
Practice Address - Street 1:4777 E OUTER DRIVE
Practice Address - Street 2:ADVANTAGE FAMILY HEALTH
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48234
Practice Address - Country:US
Practice Address - Phone:313-369-1960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002939363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIS85974Medicare UPIN
MI0N33470084Medicare ID - Type Unspecified