Provider Demographics
NPI:1780658682
Name:DEIGHAN, KAREN JOAN (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:JOAN
Last Name:DEIGHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2160 S 1ST AVE
Mailing Address - Street 2:BLDG. 103, ROOM 1016
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153-3328
Mailing Address - Country:US
Mailing Address - Phone:708-216-3380
Mailing Address - Fax:708-216-6148
Practice Address - Street 1:1950 HARLEM AVE
Practice Address - Street 2:
Practice Address - City:NORTH RIVERSIDE
Practice Address - State:IL
Practice Address - Zip Code:60546-1470
Practice Address - Country:US
Practice Address - Phone:708-354-9250
Practice Address - Fax:708-354-8765
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36076433207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E54916Medicare UPIN