MEDICARE: KAREN A O ROURKE DDS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	2901014123	MI

General Provider Information

NPI Number	:	1013099092
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAREN A O ROURKE DDS PC

Provider Business Mailing Address
First Line	:	4250 KALAMAZOO SE STE 1
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49508-3607
Country	:	US
Telephone Number	:	616-455-7930
Fax Number	:	616-455-9952

Provider Business Practice Location Address
First Line	:	4250 KALAMAZOO SE STE 1
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49508-3607
Country	:	US
Telephone Number	:	616-455-7930
Fax Number	:	616-455-9952

Authorized Official
Title or Position	:	DENTIST PRESIDENT
Name	:	DR. KAREN A O ROURKE
Credential	:	DDS
Telephone Number	:	616-455-7930

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	08/22/2020

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