Healthcare Provider Details

I. General information

NPI: 1730159161
Provider Name (Legal Business Name): KAREN MARGARET CZUBA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 04/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

INMAN MILLS 15990 HWY 221
ENOREE SC
29335
US

IV. Provider business mailing address

320 CARRIAGE GATE DR
WELLFORD SC
29385-9386
US

V. Phone/Fax

Practice location:
  • Phone: 864-909-1951
  • Fax:
Mailing address:
  • Phone: 864-909-1951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number17110
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: