Provider Demographics
NPI:1669495776
Name:ACKERMAN, KAREN M (DPM)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:ACKERMAN
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 1:2300 N 14TH AVE
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-2368
Mailing Address - Country:US
Mailing Address - Phone:620-225-7829
Mailing Address - Fax:620-225-4827
Practice Address - Street 1:2300 N 14TH AVE
Practice Address - Street 2:SUITE 100A
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-2368
Practice Address - Country:US
Practice Address - Phone:620-225-7829
Practice Address - Fax:620-225-4827
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12-00286213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS114024OtherBCBS
KS3893950001Medicare NSC
KSU70471Medicare UPIN
KS114024OtherBCBS
KS114024Medicare ID - Type UnspecifiedMEDICARE