Provider Demographics
NPI:1972709046
Name:BRENOT, KAREN ANN (DO)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:ANN
Last Name:BRENOT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:KAREN
Other - Middle Name:ANN
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:4480 UTICA RIDGE RD
Mailing Address - Street 2:SUITE 1140
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-1656
Mailing Address - Country:US
Mailing Address - Phone:563-742-5700
Mailing Address - Fax:563-742-5705
Practice Address - Street 1:4480 UTICA RIDGE RD
Practice Address - Street 2:SUITE 1140
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-1656
Practice Address - Country:US
Practice Address - Phone:563-742-5700
Practice Address - Fax:563-742-5705
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016468207V00000X
IA3956207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1972709046Medicaid
IA1972709046Medicaid
IL813590015Medicare PIN
IA54454012Medicare PIN