Provider Demographics
NPI:1467452383
Name:BOHEEN, KAREN (DO)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:BOHEEN
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 1:1492 W ANTELOPE DR
Mailing Address - Street 2:#205
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-1139
Mailing Address - Country:US
Mailing Address - Phone:801-728-0600
Mailing Address - Fax:801-728-0606
Practice Address - Street 1:1492 W ANTELOPE DR
Practice Address - Street 2:#205
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1139
Practice Address - Country:US
Practice Address - Phone:801-728-0600
Practice Address - Fax:801-728-0606
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-21
Last Update Date:2007-07-08
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-07
Provider Licenses
StateLicense IDTaxonomies
UT99-370139-1204207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTG52485Medicare UPIN