Basic Information
Provider Information
NPI: 1285690529
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BIGMAN
FirstName: KARIN
MiddleName: P
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 102222
Address2: ATTN: CREDENTIALING DEPT.
City: ATLANTA
State: GA
PostalCode: 303682222
CountryCode: US
TelephoneNumber: 2392748200
FaxNumber:  
Practice Location
Address1: 224 MEMORIAL MEDICAL PKWY
Address2: SUITE 300
City: DAYTONA BEACH
State: FL
PostalCode: 321175122
CountryCode: US
TelephoneNumber: 3862314060
FaxNumber: 3866159119
Other Information
ProviderEnumerationDate: 04/25/2006
LastUpdateDate: 04/29/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/29/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RX0202XME69196FLY Allopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
207RH0000XME69196FLN Allopathic & Osteopathic PhysiciansInternal MedicineHematology

ID Information
IDTypeStateIssuerDescription
00830420005FL MEDICAID


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