Provider Demographics
NPI:1699744771
Name:HALL, KAREN PATRICIA (MD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:PATRICIA
Last Name:HALL
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:PO BOX 5545
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47903-5545
Mailing Address - Country:US
Mailing Address - Phone:765-448-8000
Mailing Address - Fax:765-448-8335
Practice Address - Street 1:1 OAKVIEW DR
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IN
Practice Address - Zip Code:47960-1561
Practice Address - Country:US
Practice Address - Phone:765-448-8000
Practice Address - Fax:765-448-8335
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01049441A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN10825205OtherCAQH NUMBER
IN000000189382OtherANTHEM PROVIDER NUMBER
IN200217910Medicaid
IN199190JMedicare PIN
IN815510BBBMedicare PIN
IN000000189382OtherANTHEM PROVIDER NUMBER
IN10825205OtherCAQH NUMBER
IN142080LMedicare PIN
IN080138836Medicare PIN