Provider Demographics
NPI:1770654279
Name:LARSEN, KAREN BENEDICTE (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:BENEDICTE
Last Name:LARSEN
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 1:402 COUNTY ROAD D W
Mailing Address - Street 2:MEDTOX LABORATORIES, INC.
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55112-3522
Mailing Address - Country:US
Mailing Address - Phone:651-628-6115
Mailing Address - Fax:
Practice Address - Street 1:402 COUNTY ROAD D W
Practice Address - Street 2:MEDTOX LABORATORIES, INC.
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55112-3522
Practice Address - Country:US
Practice Address - Phone:651-628-6115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN46238207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND10387Medicaid
SD7777470Medicaid
IA0571638Medicaid
1040004OtherPREFERREDONE
11-00014OtherMEDICA - PRIMARY
2032911OtherARAZ
HP40145OtherHEALTHPARTNERS
11-00380OtherMEDICA - CHOICE
131144OtherUCARE
WI34454100Medicaid
MN610942000Medicaid
MN610942000Medicaid
WI34454100Medicaid