Provider Demographics
NPI:1982613535
Name:MILJOUR, KAREN R (DO)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:R
Last Name:MILJOUR
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 1:3009 N SAGINAW RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-4555
Mailing Address - Country:US
Mailing Address - Phone:989-633-1350
Mailing Address - Fax:989-633-1355
Practice Address - Street 1:3009 N SAGINAW RD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-4555
Practice Address - Country:US
Practice Address - Phone:989-633-1350
Practice Address - Fax:989-633-1355
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI55665207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI222450388Medicare PIN
MIG91489Medicare UPIN
MI0M05250025Medicare ID - Type Unspecified
MI4201858Medicaid