Healthcare Provider Details

I. General information

NPI: 1194790378
Provider Name (Legal Business Name): KAREN SUE WATSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 10/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N MAYFAIR RD 2ND FLOOR
WAUWATOSA WI
53226-4216
US

IV. Provider business mailing address

201 N MAYFAIR RD 2ND FLOOR
WAUWATOSA WI
53226-4216
US

V. Phone/Fax

Practice location:
  • Phone: 414-771-8228
  • Fax: 414-256-2483
Mailing address:
  • Phone: 414-771-8228
  • Fax: 414-256-2483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number35187
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: