Provider Demographics
NPI:1356422851
Name:MENN, KAREN EVASKITIS (DO)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:EVASKITIS
Last Name:MENN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2747
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-2662
Mailing Address - Country:US
Mailing Address - Phone:843-357-1299
Mailing Address - Fax:843-357-2264
Practice Address - Street 1:4630 HWY 17 BYPASS
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-5016
Practice Address - Country:US
Practice Address - Phone:843-357-1299
Practice Address - Fax:843-357-2264
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC290207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTL0736Medicaid
SC7451Medicare PIN
SCTL0736Medicaid