Provider Demographics
NPI:1699863142
Name:MOELLER, KAREN K (MD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:K
Last Name:MOELLER
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 1:7625 ASHLEYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-1563
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6701 FANNIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2608
Practice Address - Country:US
Practice Address - Phone:832-824-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY377662085P0229X
TXT74402085P0229X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000544151OtherANTHEM - KCR
KY000023029YOtherHUMANA - KCR
KY91709OtherSIHO - KCR
KY2442247000OtherPAD - KCR
KY50016963OtherPASSPORT - KCR
KY64064330Medicaid
IN200431700Medicaid
KY00533036Medicare PIN
KY000023029YOtherHUMANA - KCR