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General NPI Number Information
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NPI Number | 1750317558
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Entity Type | Individual
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Provider Name | KAREN BETTS MIELKE MD, JD
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Gender | Female
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 500 W. BROADWAY ST
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City | MISSOULA
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State | MT
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Zip | 59806-4587
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Country | US
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Telephone | 406-329-5776
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Fax | 406-327-1796
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Provider Business Mailing Address
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Address Line | 682 STERLING ST S
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City | MAPLEWOOD
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State | MN
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Zip | 55119-6783
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Country | US
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Telephone | 651-735-7703
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Fax | 651-735-3453
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 9533
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 32700
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 34991 - 20
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License Number State | WI
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