Provider Demographics
NPI:1982694816
Name:DICKE, KAREN T (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:T
Last Name:DICKE
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 1:5901 TECHNOLOGY CENTER DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-6013
Mailing Address - Country:US
Mailing Address - Phone:317-328-5050
Mailing Address - Fax:317-715-9965
Practice Address - Street 1:5901 TECHNOLOGY CENTER DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-6013
Practice Address - Country:US
Practice Address - Phone:317-328-5050
Practice Address - Fax:317-715-9965
Is Sole Proprietor?:No
Enumeration Date:2005-10-22
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01041270A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000492341OtherANTHEM 203778927
IN100348890Medicaid
IN300113616OtherRR MEDICARE-351158723
IN000000111060OtherANTHEM-351158723
IN005556OtherSIHO-351158723
IN108057OtherHEALTH ALLIANCE-351158723
INQ0086512OtherCMOSHO351158723&352047427
INE76558Medicare UPIN
IN300113616OtherRR MEDICARE-351158723