Provider Demographics
NPI:1679524409
Name:HULBERT, KAREN A (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:A
Last Name:HULBERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1155 N MAYFAIR RD
Mailing Address - Street 2:PLANK ROAD CLINIC
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3462
Mailing Address - Country:US
Mailing Address - Phone:414-955-5990
Mailing Address - Fax:414-955-6282
Practice Address - Street 1:502 W WATER ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WI
Practice Address - Zip Code:54968-9141
Practice Address - Country:US
Practice Address - Phone:920-295-6432
Practice Address - Fax:920-295-4833
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI45973207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1679524409Medicaid
006906261LOtherHUMANA
WI1679524409Medicaid
WI736011512Medicare PIN
G32074Medicare UPIN