Provider Demographics
NPI:1639127483
Name:EDISON, KAREN E (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:E
Last Name:EDISON
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:PO BOX 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:1020 HITT STREET
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-0001
Practice Address - Country:US
Practice Address - Phone:573-882-4800
Practice Address - Fax:573-884-0723
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO102931207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO463818OtherHEALTHLINK
MO148466OtherBLUE SHIELD/BLUE CHOICE
MO206705105Medicaid
MO381027OtherUNITED HEALTHCARE
F62871Medicare UPIN
MO148466OtherBLUE SHIELD/BLUE CHOICE
MO463818OtherHEALTHLINK
MO070015917Medicare PIN
MO319615236Medicare PIN