Provider Demographics
NPI:1659532737
Name:KARINEN, TRACY JEAN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:JEAN
Last Name:KARINEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 SOUTH BLVD E STE 300
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-6120
Mailing Address - Country:US
Mailing Address - Phone:248-844-9710
Mailing Address - Fax:
Practice Address - Street 1:37000 GRAND RIVER AVE STE 310
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48335-2868
Practice Address - Country:US
Practice Address - Phone:248-536-2127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005240363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical