Provider Demographics
NPI:1821045006
Name:KOBY-OLSON, KAREN SUE (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:SUE
Last Name:KOBY-OLSON
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 1:652 N OTSEGO AVE
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-2502
Mailing Address - Country:US
Mailing Address - Phone:989-732-3529
Mailing Address - Fax:989-732-7865
Practice Address - Street 1:652 N OTSEGO AVE
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-2502
Practice Address - Country:US
Practice Address - Phone:989-732-3529
Practice Address - Fax:989-732-7865
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301030249208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4663567Medicaid
MI4663567Medicaid
0P01390002Medicare PIN