Provider Demographics
NPI:1710953443
Name:DORN, KAREN T (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:T
Last Name:DORN
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 1:1805 WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:MN
Mailing Address - Zip Code:56215
Mailing Address - Country:US
Mailing Address - Phone:320-843-2030
Mailing Address - Fax:320-314-1542
Practice Address - Street 1:1805 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:MN
Practice Address - Zip Code:56215
Practice Address - Country:US
Practice Address - Phone:320-843-2030
Practice Address - Fax:320-314-1542
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN43134207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN087744100Medicaid
MN087744100Medicaid
H67289Medicare UPIN