Healthcare Provider Details

I. General information

NPI: 1851499099
Provider Name (Legal Business Name): KAREN MARY PARK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5333 MCAULEY DR RM 1000
YPSILANTI MI
48197-1024
US

IV. Provider business mailing address

5333 MCAULEY DR RM 1000
YPSILANTI MI
48197-1024
US

V. Phone/Fax

Practice location:
  • Phone: 734-712-5898
  • Fax: 734-712-5084
Mailing address:
  • Phone: 734-712-5898
  • Fax: 734-712-5084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number4301079007
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: