Healthcare Provider Details

I. General information

NPI: 1942414701
Provider Name (Legal Business Name): KAREN KRAUSE KOEPPE R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3174 PACKARD ST
ANN ARBOR MI
48108-1947
US

IV. Provider business mailing address

2180 STEEPLECHASE DR
ANN ARBOR MI
48103-6033
US

V. Phone/Fax

Practice location:
  • Phone: 734-971-1073
  • Fax: 734-971-8545
Mailing address:
  • Phone: 734-995-1852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: