Provider Demographics
NPI:1861400731
Name:BEIMBORN, KAREN A (MEDICINE SURGERY MD)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:A
Last Name:BEIMBORN
Suffix:
Gender:F
Credentials:MEDICINE SURGERY MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 396
Mailing Address - Street 2:5409 EVERYBODYS ROAD FOREST COUNTY POTAWATOMI HEALTH
Mailing Address - City:CRANDON
Mailing Address - State:WI
Mailing Address - Zip Code:54520
Mailing Address - Country:US
Mailing Address - Phone:715-478-4300
Mailing Address - Fax:715-478-4490
Practice Address - Street 1:5409 EVERYBODYS ROAD
Practice Address - Street 2:FOREST COUNTY POTAWATOMI HEALTH & WELLNESS CENTER
Practice Address - City:CRANDON
Practice Address - State:WI
Practice Address - Zip Code:54520
Practice Address - Country:US
Practice Address - Phone:715-478-4300
Practice Address - Fax:715-478-4490
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI29406207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI93393OtherSECURITY HEALTH PLAN
WI31590500Medicaid
WI31590500Medicaid