Provider Demographics
NPI:1194354977
Name:FU, KAREN
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:FU
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 1:31 E OGDEN AVE UNIT 118
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-2095
Mailing Address - Country:US
Mailing Address - Phone:720-470-6427
Mailing Address - Fax:
Practice Address - Street 1:31 E OGDEN AVE UNIT 118
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-2095
Practice Address - Country:US
Practice Address - Phone:720-470-6427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-03
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL385006060363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty