Provider Demographics
NPI:1649541731
Name:TAGTMEYER, KAREN BETH (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:BETH
Last Name:TAGTMEYER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:BETH
Other - Last Name:AUGUSTYN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 544
Mailing Address - Street 2:DEPT 5390
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53201-0544
Mailing Address - Country:US
Mailing Address - Phone:815-713-2600
Mailing Address - Fax:815-654-8020
Practice Address - Street 1:391 S BOLINGBROOK DR
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-3411
Practice Address - Country:US
Practice Address - Phone:630-226-1006
Practice Address - Fax:630-226-9003
Is Sole Proprietor?:No
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.003160363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant