Provider Demographics
NPI:1922287614
Name:SMITH, KAREN A (PA)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:A
Other - Last Name:LARSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8110 S CASS AVE
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-5013
Mailing Address - Country:US
Mailing Address - Phone:630-920-1900
Mailing Address - Fax:630-920-1901
Practice Address - Street 1:8110 S CASS AVE
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:IL
Practice Address - Zip Code:60561-5013
Practice Address - Country:US
Practice Address - Phone:630-920-1900
Practice Address - Fax:630-920-1901
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-002981363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant