Provider Demographics
NPI:1588646285
Name:SLETTEN-FARJO, KARIN R (MD)
Entity Type:Individual
Prefix:DR
First Name:KARIN
Middle Name:R
Last Name:SLETTEN-FARJO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KARIN
Other - Middle Name:R
Other - Last Name:SLETTEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:325 WINDYCREST DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-3014
Mailing Address - Country:US
Mailing Address - Phone:734-913-8884
Mailing Address - Fax:
Practice Address - Street 1:2305 GENOA BUSINESS PARK DRIVE
Practice Address - Street 2:SUITE 250
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114
Practice Address - Country:US
Practice Address - Phone:810-494-2020
Practice Address - Fax:810-494-0127
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI45792207W00000X
MI4301070940207W00000X, 207WX0107X
IA34023207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIBCBSM PIN#Other18-0-82-5458-1
WI34425300Medicaid
H45963Medicare UPIN
MIP30920002Medicare PIN
WI000447695Medicare ID - Type Unspecified
WI34425300Medicaid
WI000674110Medicare ID - Type Unspecified
MIP30920002Medicare ID - Type UnspecifiedBRIGHTON VISION CENTER #