Provider Demographics
NPI:1083633523
Name:JANSON, KAREN L (MD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:L
Last Name:JANSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 S BAILEY AVE
Mailing Address - Street 2:SUITE 2-1
Mailing Address - City:SOUTH HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49090-6743
Mailing Address - Country:US
Mailing Address - Phone:269-639-2772
Mailing Address - Fax:269-639-2770
Practice Address - Street 1:955 S BAILEY AVE
Practice Address - Street 2:SUITE 2-1
Practice Address - City:SOUTH HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49090-6743
Practice Address - Country:US
Practice Address - Phone:269-639-2772
Practice Address - Fax:269-639-2770
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301053992208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4546177 T77Medicaid
MIF48176Medicare UPIN