Provider Demographics
NPI:1861423691
Name:THOMPSON, KAREN S (DO)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:S
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:LAWRENCE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:700 DOCTORS CT
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-7314
Mailing Address - Country:US
Mailing Address - Phone:352-787-9838
Mailing Address - Fax:352-787-8705
Practice Address - Street 1:700 DOCTORS CT
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-7314
Practice Address - Country:US
Practice Address - Phone:352-787-9838
Practice Address - Fax:352-787-8705
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS15058208G00000X
IL036.121407208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOS15058OtherSTATE MEDICAL LICENSE
FLIB01FOtherBCBS
FL023537300Medicaid