Provider Demographics
NPI:1619080496
Name:GINN, KAREN RUTH (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:RUTH
Last Name:GINN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1101 TIMBERLINE LN
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-4453
Mailing Address - Country:US
Mailing Address - Phone:218-786-0632
Mailing Address - Fax:
Practice Address - Street 1:6887 S LAKE AVE
Practice Address - Street 2:
Practice Address - City:LAKE NEBAGAMON
Practice Address - State:WI
Practice Address - Zip Code:54849-0266
Practice Address - Country:US
Practice Address - Phone:715-374-2070
Practice Address - Fax:715-374-2072
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN43933207Q00000X
WI43689207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F58968Medicare UPIN