Provider Demographics
NPI:1912906447
Name:MITCHELL, KAREN BARNES (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:BARNES
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:15990 W 9 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4826
Mailing Address - Country:US
Mailing Address - Phone:248-849-4226
Mailing Address - Fax:248-849-4240
Practice Address - Street 1:22250 PROVIDENCE DR
Practice Address - Street 2:500
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4825
Practice Address - Country:US
Practice Address - Phone:248-849-3441
Practice Address - Fax:258-849-5389
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2011-02-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301051167207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI269028910Medicaid
MI0F36020031Medicare ID - Type Unspecified
MIE77736Medicare UPIN