MEDICARE: KAREN ELAINE PAGE

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	347C00000X	Private Vehicle	GGS1813	OH

General Provider Information

NPI Number	:	1174125173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN ELAINE PAGE

Provider Business Mailing Address
First Line	:	6413 FERNHURST AVE
Second Line	:
City	:	PARMA HEIGHTS
State	:	OH
Zip	:	44130-2829
Country	:	US
Telephone Number	:	440-655-0579
Fax Number	:

Provider Business Practice Location Address
First Line	:	6413 FERNHURST AVE
Second Line	:
City	:	PARMA HEIGHTS
State	:	OH
Zip	:	44130-2829
Country	:	US
Telephone Number	:	440-655-0579
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2020
Last Update Date	:	11/13/2020

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