Provider Demographics
NPI:1629048293
Name:MAVES, KAREN K (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:K
Last Name:MAVES
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 1:2112 E 38TH STREET
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807
Mailing Address - Country:US
Mailing Address - Phone:563-359-0324
Mailing Address - Fax:563-359-9409
Practice Address - Street 1:2112 E 38TH STREET
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807
Practice Address - Country:US
Practice Address - Phone:563-359-0324
Practice Address - Fax:563-359-9409
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036113636207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00306916OtherRR MEDICARE
IL036113636Medicaid
ILP00306916OtherRR MEDICARE
IL036113636Medicaid
ILK188323Medicare ID - Type Unspecified