Provider Demographics
NPI:1215034871
Name:POTCHYNOK-LUND, KAREN MARIE (DPM)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:MARIE
Last Name:POTCHYNOK-LUND
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18645 CANAL RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-5822
Mailing Address - Country:US
Mailing Address - Phone:586-228-9660
Mailing Address - Fax:586-228-1324
Practice Address - Street 1:18645 CANAL RD
Practice Address - Street 2:SUITE 5
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-5822
Practice Address - Country:US
Practice Address - Phone:586-228-9660
Practice Address - Fax:586-228-1324
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKP001517213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU19725Medicare UPIN
5505823Medicare ID - Type Unspecified