Provider Demographics
NPI:1154391720
Name:VANKEULEN, KARLA A (MD)
Entity type:Individual
Prefix:DR
First Name:KARLA
Middle Name:A
Last Name:VANKEULEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KARLA
Other - Middle Name:A
Other - Last Name:POLASCHEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:600 JOHN DEERE ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6897
Mailing Address - Country:US
Mailing Address - Phone:309-779-4200
Mailing Address - Fax:309-779-4305
Practice Address - Street 1:600 JOHN DEERE ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6897
Practice Address - Country:US
Practice Address - Phone:309-779-4200
Practice Address - Fax:309-779-4305
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036092450207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036092450Medicaid
IL160036154OtherRR MEDICARE
IL160036154OtherRR MEDICARE
ILL92345Medicare ID - Type Unspecified