MEDICARE: DR. KAREN MICHELLE ELLER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	33094	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	21483	OTHER	SC	STATE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	33094	OTHER	SC	SPECIALTY LICENSE
4	201486939	OTHER	SC	PROVIDER TAXID
5	ELKA	OTHER	SC	TAXIDSUFFIX

General Provider Information

NPI Number	:	1205888765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAREN MICHELLE ELLER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 478
Second Line	:
City	:	PORT ROYAL
State	:	SC
Zip	:	29935-0478
Country	:	US
Telephone Number	:	843-522-3456
Fax Number	:	843-522-8263

Provider Business Practice Location Address
First Line	:	41A MARSHELLEN DR
Second Line	:	PALMETTO PAIN PA
City	:	BEAUFORT
State	:	SC
Zip	:	29902-6900
Country	:	US
Telephone Number	:	843-522-3456
Fax Number	:	843-522-8263

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	03/07/2023

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