Provider Demographics
NPI:1386642759
Name:WASSERMAN, KAREN (DPM)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:
Last Name:WASSERMAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5925 FOREST LN STE 301
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2772
Mailing Address - Country:US
Mailing Address - Phone:214-350-3111
Mailing Address - Fax:214-350-1318
Practice Address - Street 1:5925 FOREST LN STE 301
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2772
Practice Address - Country:US
Practice Address - Phone:214-350-1311
Practice Address - Fax:214-350-1318
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0822213E00000X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0822OtherTX LICENSE
2654990001OtherPTAN
2654990001Medicare NSC