Healthcare Provider Details

I. General information

NPI: 1376127639
Provider Name (Legal Business Name): KAREEN SHAW DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COCHRANE CIR UNIT MEDDAC
FORT CARSON CO
80913-4604
US

IV. Provider business mailing address

1650 COCHRANE CIR UNIT MEDDAC
FORT CARSON CO
80913-4604
US

V. Phone/Fax

Practice location:
  • Phone: 719-761-0075
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number0102207421
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: