Provider Demographics
NPI:1407872591
Name:ENGLUND, KAREN JOYCE (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:JOYCE
Last Name:ENGLUND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:JOYCE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1954 GATEWAY CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BELVIDERE
Mailing Address - State:IL
Mailing Address - Zip Code:61008-9303
Mailing Address - Country:US
Mailing Address - Phone:815-547-3780
Mailing Address - Fax:815-547-3781
Practice Address - Street 1:1954 GATEWAY CENTER DR
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:IL
Practice Address - Zip Code:61008-9303
Practice Address - Country:US
Practice Address - Phone:815-547-3780
Practice Address - Fax:815-547-3781
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036067020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036067020Medicaid
IL553180OtherMEDICARE GROUP PTAN
ILC42742Medicare UPIN
ILCC5050Medicare ID - Type UnspecifiedRR MEDICARE GROUP #
IL834340Medicare ID - Type UnspecifiedMEDICARE GROUP #
IL036067020Medicaid
IL5531800018Medicare PIN
ILL36983Medicare ID - Type Unspecified