Provider Demographics
NPI:1730730789
Name:MARCUM, KAREN
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:MARCUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4165 BLACKHAWK PLAZA CIRCLE
Mailing Address - Street 2:PRIVATE SUITE 250
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94506
Mailing Address - Country:US
Mailing Address - Phone:510-300-5221
Mailing Address - Fax:
Practice Address - Street 1:4165 BLACKHAWK PLAZA CIRCLE
Practice Address - Street 2:PRIVATE SUITE 250
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94506
Practice Address - Country:US
Practice Address - Phone:510-300-5221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-21
Last Update Date:2019-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAKK358154335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier