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General NPI Number Information
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NPI Number | 1679545453
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Entity Type | Individual
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Provider Name | KAREN A MOELLER MD
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Gender | Female
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Dates
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Enumeration Date | 02/06/2006
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Last Update Date | 08/14/2008
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Provider Practice Location Address
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Address Line | 640 JACKSON ST
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City | SAINT PAUL
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State | MN
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Zip | 55101-2502
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Country | US
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Telephone | 123-123-1234
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Fax | 763-287-5019
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Provider Business Mailing Address
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Address Line | 8100 34TH AVE S MC21110Q
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City | BLOOMINGTON
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State | MN
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Zip | 55425-1672
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Country | US
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Telephone | 123-123-1234
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Fax | 763-287-5019
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 42006
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License Number State | MN
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