Provider Demographics
NPI:1720183890
Name:EKWUEME, KAREN GAYL (MD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:GAYL
Last Name:EKWUEME
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:GAYL
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1025 PEERLESS XING NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-3764
Mailing Address - Country:US
Mailing Address - Phone:423-476-5990
Mailing Address - Fax:423-476-5887
Practice Address - Street 1:1521 GUNBARREL RD # 103
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3124
Practice Address - Country:US
Practice Address - Phone:423-531-0911
Practice Address - Fax:423-531-0912
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN66165207Q00000X
MA265023207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI61036OtherDEAN HEALTH SYSTEMS, INC
WI543400518Medicare PIN
WIP00874284Medicare PIN
WIK400111040Medicare PIN