Basic Information
Provider Information
NPI: 1447471636
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KARENKO
FirstName: BARBARA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5900 BYRON CENTER AVE SW
Address2: MEDICAL ADMINISTRATION
City: WYOMING
State: MI
PostalCode: 495199606
CountryCode: US
TelephoneNumber: 6162523243
FaxNumber: 6162520260
Practice Location
Address1: 2122 HEALTH DR SW
Address2:  
City: WYOMING
State: MI
PostalCode: 495199698
CountryCode: US
TelephoneNumber: 6162525950
FaxNumber: 6162525956
Other Information
ProviderEnumerationDate: 05/02/2007
LastUpdateDate: 12/05/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RI0011X5101015564MIN Allopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
207RC0000X5101015564MIY Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease

No ID Information.


Home