Provider Demographics
NPI:1720183890
Name:EKWUEME, KAREN GAYL (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:GAYL
Last Name:EKWUEME
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:GAYL
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:366 SHREWSBURY ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-4647
Mailing Address - Country:US
Mailing Address - Phone:508-595-2700
Mailing Address - Fax:774-221-5136
Practice Address - Street 1:73D WINTHROP AVE
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-3716
Practice Address - Country:US
Practice Address - Phone:978-686-3017
Practice Address - Fax:978-685-4280
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI54560-20207Q00000X
MA265023207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI61036OtherDEAN HEALTH SYSTEMS, INC
WI543400518Medicare PIN
WIP00874284Medicare PIN
WIK400111040Medicare PIN