MEDICARE: DR. KAREN SELIN BLACKMAN M.D.

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	2084P0800X	Psychiatry Physician	4301043893	MI
2	207Q00000X	Family Medicine Physician	4301043893	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255377560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAREN SELIN BLACKMAN M.D.

Provider Business Mailing Address
First Line	:	804 SERVICE RD # A201
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48824-7015
Country	:	US
Telephone Number	:	517-884-2976
Fax Number	:	517-432-3928

Provider Business Practice Location Address
First Line	:	463 E CIRCLE DR
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48824-7500
Country	:	US
Telephone Number	:	517-353-8737
Fax Number	:	517-432-9460

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

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	08/12/2016

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