Provider Demographics
NPI:1851499099
Name:PARK, KAREN MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:MARY
Last Name:PARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5325 ELLIOTT DRIVE
Mailing Address - Street 2:SUITE 100 ST. JOSEPH MERCY PAIN INSTITUTE
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-1566
Mailing Address - Country:US
Mailing Address - Phone:734-712-5898
Mailing Address - Fax:734-712-5084
Practice Address - Street 1:5325 ELLIOTT DRIVE
Practice Address - Street 2:SUITE 100 ST. JOSEPH MERCY PAIN INSTITUTE
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48105-1566
Practice Address - Country:US
Practice Address - Phone:734-712-5898
Practice Address - Fax:734-712-5084
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301079007208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI138112OtherCARE CHOICE INDIVIDUAL NO
MI1243118OtherUNITED HEALTHCARE NO
MI5412048OtherAETNA INDIVIDUAL NO
MI0813610OtherBCBS OF MI PIN
MI1243118OtherUNITED HEALTHCARE NO
MIN76360004Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL NO