Provider Demographics
NPI:1699737353
Name:RICKERT, KAREN H (DO)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:H
Last Name:RICKERT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3933 ASHLEY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-8158
Mailing Address - Country:US
Mailing Address - Phone:440-915-6235
Mailing Address - Fax:
Practice Address - Street 1:3933 ASHLEY LAKE RD
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-8158
Practice Address - Country:US
Practice Address - Phone:440-915-6235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT104068207Q00000X
OH34006126207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G64700Medicare UPIN