Healthcare Provider Details

I. General information

NPI: 1740262534
Provider Name (Legal Business Name): KAREN S ISRAEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 01/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5265 E 82ND ST PMB 318
INDIANAPOLIS IN
46250-1627
US

IV. Provider business mailing address

5265 E 82ND ST PMB 318
INDIANAPOLIS IN
46250-1627
US

V. Phone/Fax

Practice location:
  • Phone: 317-403-5131
  • Fax: 317-863-8192
Mailing address:
  • Phone: 317-403-5131
  • Fax: 317-863-8192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number01025067A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: