Basic Information
| Provider Information | |||||||||
| NPI: | 1902805732 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHEEHAN | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 74289 | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441940002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8664399184 | ||||||||
| FaxNumber: | 6147649147 | ||||||||
| Practice Location | |||||||||
| Address1: | 1101 DECATUR ST | ||||||||
| Address2: | |||||||||
| City: | SANDUSKY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 448703335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8664399184 | ||||||||
| FaxNumber: | 6147649147 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2005 | ||||||||
| LastUpdateDate: | 09/05/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 35-06-4189-S | OH | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 0247736 | 05 | OH | MEDICAID |