Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QG0300X | Family Doctor - Geriatric Medicine | 4301043177 | MI |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 4301043177 | MI |
NPI | 1083721989 |
---|---|
Provider Name | Dr. Karen Sue Ogle |
First Address | Grand Rapids, MI 49503 |
Second Address | Grand Rapids, MI 49503 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 16/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D72571 | (02) |