Provider Demographics
NPI:1750317558
Name:MIELKE, KAREN BETTS (MD, JD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:BETTS
Last Name:MIELKE
Suffix:
Gender:F
Credentials:MD, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:682 STERLING ST S
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55119-6783
Mailing Address - Country:US
Mailing Address - Phone:651-735-7703
Mailing Address - Fax:651-735-3453
Practice Address - Street 1:500 W. BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59806-4587
Practice Address - Country:US
Practice Address - Phone:406-329-5776
Practice Address - Fax:406-327-1796
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9533208000000X
MN32700208000000X
WI34991 - 20208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics