MEDICARE: DR. KAREN CHRISTINE CUMMISKEY 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	4301062865	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235127911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAREN CHRISTINE CUMMISKEY M.D.

Provider Business Mailing Address
First Line	:	1000 E PARIS AVE SE
Second Line	:	SUITE 210
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-3680
Country	:	US
Telephone Number	:	616-285-3310
Fax Number	:	616-285-3266

Provider Business Practice Location Address
First Line	:	1000 E PARIS AVE SE
Second Line	:	SUITE 210
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-3680
Country	:	US
Telephone Number	:	616-285-3310
Fax Number	:	616-285-3266

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

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	07/08/2007

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