Provider Demographics
NPI:1598808073
Name:KAREN B HIMMEL MD SC
Entity Type:Organization
Organization Name:KAREN B HIMMEL MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:B
Authorized Official - Last Name:HIMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:715-732-4463
Mailing Address - Street 1:W3959 PANSKE RD
Mailing Address - Street 2:
Mailing Address - City:PORTERFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54159-9616
Mailing Address - Country:US
Mailing Address - Phone:715-732-4463
Mailing Address - Fax:715-735-9334
Practice Address - Street 1:W3959 PANSKE RD
Practice Address - Street 2:
Practice Address - City:PORTERFIELD
Practice Address - State:WI
Practice Address - Zip Code:54159-9616
Practice Address - Country:US
Practice Address - Phone:715-732-4463
Practice Address - Fax:715-735-9334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI34414207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34414OtherLICENSE NUMBER
WI31952800Medicaid
MI4301053035OtherLICENSE NUMBER
MI4301053035OtherLICENSE NUMBER
WI34414OtherLICENSE NUMBER