Provider Demographics
NPI:1558570580
Name:POWERS, KAREN LYNNE (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LYNNE
Last Name:POWERS
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 1:3901 STONEGATE PARK
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-9137
Mailing Address - Country:US
Mailing Address - Phone:269-556-6000
Mailing Address - Fax:
Practice Address - Street 1:3901 STONEGATE PARK
Practice Address - Street 2:SUITE 300
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-9137
Practice Address - Country:US
Practice Address - Phone:269-556-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7665984-1205208200000X
MI4301108662208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1558570580Medicaid