Provider Demographics
NPI:1891265864
Name:CHAMPAGNE, KARLAN
Entity Type:Individual
Prefix:
First Name:KARLAN
Middle Name:
Last Name:CHAMPAGNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23215 COMMERENCE PARK
Mailing Address - Street 2:306
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122
Mailing Address - Country:US
Mailing Address - Phone:216-532-3427
Mailing Address - Fax:216-502-2803
Practice Address - Street 1:23215 COMMERENCE PARK
Practice Address - Street 2:306
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122
Practice Address - Country:US
Practice Address - Phone:216-532-3427
Practice Address - Fax:216-502-2803
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management