Provider Demographics
NPI:1255377560
Name:BLACKMAN, KAREN SELIN (MD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:SELIN
Last Name:BLACKMAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:804 SERVICE RD # A201
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-884-2976
Mailing Address - Fax:517-432-3928
Practice Address - Street 1:463 E CIRCLE DR
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-7500
Practice Address - Country:US
Practice Address - Phone:517-353-8737
Practice Address - Fax:517-432-9460
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2016-08-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI43010438932084P0800X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4783458Medicaid
MI1255377560Medicaid
MIC36160038Medicare PIN
MI1255377560Medicaid
MI4783458Medicaid