Provider Demographics
NPI:1699706119
Name:BETTEN, KAREN L (MD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:BETTEN
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 1:8191 MOORSBRIDGE RD STE A
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-7417
Mailing Address - Country:US
Mailing Address - Phone:269-779-0797
Mailing Address - Fax:888-287-4873
Practice Address - Street 1:8191 MOORSBRIDGE RD STE A
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-7417
Practice Address - Country:US
Practice Address - Phone:269-779-0797
Practice Address - Fax:888-287-4873
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2020-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI46165-20207Q00000X
MI4301078902207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200086430AMedicaid
OKG44735Medicare UPIN
OK200086430AMedicaid
OK242623303Medicare PIN