Healthcare Provider Details

I. General information

NPI: 1366409393
Provider Name (Legal Business Name): KAREN ANN KLAWITTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAREN A. MIKSCH

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 04/15/2025
Certification Date: 03/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 W JACKSON STREET
PENSACOLA FL
32505
US

IV. Provider business mailing address

3922 MERCY DR
MCHENRY IL
60050-3179
US

V. Phone/Fax

Practice location:
  • Phone: 850-436-4630
  • Fax: 815-344-4779
Mailing address:
  • Phone: 815-344-4499
  • Fax: 815-344-4779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036104165
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME157185
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: