Provider Demographics
NPI:1437341625
Name:KARMACK LLC
Entity Type:Organization
Organization Name:KARMACK LLC
Other - Org Name:KEIL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:HALLER
Authorized Official - Last Name:KEIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:608-784-5249
Mailing Address - Street 1:20 COPELAND AVE
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54603-3401
Mailing Address - Country:US
Mailing Address - Phone:608-784-5249
Mailing Address - Fax:
Practice Address - Street 1:20 COPELAND AVE
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54603-3401
Practice Address - Country:US
Practice Address - Phone:608-784-5249
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI30525207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1790766301OtherPERSONAL NPI
1790766301OtherPERSONAL NPI