Provider Demographics
NPI:1396770905
Name:TAMMELA, KAREN ROSS (MD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:ROSS
Last Name:TAMMELA
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 1:220 S PALISADE DR STE 203
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-8903
Mailing Address - Country:US
Mailing Address - Phone:805-354-7101
Mailing Address - Fax:805-354-7102
Practice Address - Street 1:220 S PALISADE DR STE 203
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-8903
Practice Address - Country:US
Practice Address - Phone:805-354-7101
Practice Address - Fax:805-354-7102
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI48141207V00000X
CAC153083207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34648200Medicaid
07125-0302Medicare ID - Type Unspecified
WI34648200Medicaid