Provider Demographics
NPI:1801826672
Name:LO, KAREN GRACE (DPM)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:GRACE
Last Name:LO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:GRACE
Other - Last Name:WAI LENG LO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1514 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2429
Mailing Address - Country:US
Mailing Address - Phone:504-842-4000
Mailing Address - Fax:
Practice Address - Street 1:8050 W JUDGE PEREZ DR
Practice Address - Street 2:
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043-1734
Practice Address - Country:US
Practice Address - Phone:504-493-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00323213ES0131X
LA323533213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0099994000Medicaid
480034391OtherRAILROAD MEDICARE
KY8000045Medicaid
OH0815578Medicaid
WV0099994000Medicaid
U12938Medicare UPIN