Provider Demographics
NPI:1326070236
Name:DAVIS, KAREN D (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:D
Last Name:DAVIS
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 1:6913 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-8039
Mailing Address - Country:US
Mailing Address - Phone:574-647-2970
Mailing Address - Fax:574-647-2971
Practice Address - Street 1:6913 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-8039
Practice Address - Country:US
Practice Address - Phone:574-647-2970
Practice Address - Fax:574-647-2971
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01064268A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200879520Medicaid
IN200879520Medicaid
IN236040G5Medicare Oscar/Certification