Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 4301505730 | MI |
Y | 208600000X | Surgeon | 4301505730 | MI |
N | 2086S0122X | Plastic and Reconstructive Surgery | 2009-01735 | NC |
N | 2086S0122X | Plastic and Reconstructive Surgery | 2170261 | NY |
N | 2086S0122X | Plastic and Reconstructive Surgery | 25MA06639100 | NJ |
NPI | 1225094659 |
---|---|
Provider Name | Dr. Karen M Buckley |
First Address | Charlotte, NC 28275-1069 |
Second Address | Portage, MI 49024-3831 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 02/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02131235170 | (05) | NY |
155UH | BCBSNC (01) | NC |
5913510 | (05) | NC |