Provider Demographics
NPI:1306915806
Name:KINDERVATER, KAREN ANN (MD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:ANN
Last Name:KINDERVATER
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 1:702 COMMERCE DR STE 150
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-5252
Mailing Address - Country:US
Mailing Address - Phone:419-874-0274
Mailing Address - Fax:419-874-9960
Practice Address - Street 1:702 COMMERCE DR STE 150
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-5252
Practice Address - Country:US
Practice Address - Phone:419-874-0274
Practice Address - Fax:419-874-9960
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-26162084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0618513Medicaid
F60589Medicare UPIN
OHKO17432101Medicare PIN