MEDICARE: DR. KAREN MICHELE DORFMAN PH.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	103G00000X	Clinical Neuropsychologist	979	OK

General Provider Information

NPI Number	:	1447261755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAREN MICHELE DORFMAN PH.D.

Provider Business Mailing Address
First Line	:	2509 PRESCOTT AVE
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73013-2917
Country	:	US
Telephone Number	:	405-285-5378
Fax Number	:

Provider Business Practice Location Address
First Line	:	3035 NW 63RD ST
Second Line	:	SUITE 227
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-3632
Country	:	US
Telephone Number	:	405-822-6872
Fax Number	:

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

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	07/08/2007

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