Provider Demographics
NPI:1669427647
Name:TODD, KAREN DAWN (MD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:DAWN
Last Name:TODD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 INDIAN RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-5225
Mailing Address - Country:US
Mailing Address - Phone:772-569-9500
Mailing Address - Fax:772-569-9507
Practice Address - Street 1:2750 INDIAN RIVER BLVD
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5225
Practice Address - Country:US
Practice Address - Phone:772-569-9500
Practice Address - Fax:772-569-9507
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0053563174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL377352300Medicaid
FL180027379OtherINDIV RR-RAILROAD MEDICAR
FL07936ZMedicare ID - Type UnspecifiedINDIV MEDICARE
FL377352300Medicaid