MEDICARE: KAREN L HIESTER DO

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	207Q00000X	Family Medicine Physician	OS12129	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	HM358Z	OTHER	FL	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14RR4	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568488476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN L HIESTER DO

Provider Business Mailing Address
First Line	:	15420 COLLIER BLVD
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34120-3917
Country	:	US
Telephone Number	:	239-624-8130
Fax Number	:	239-624-8131

Provider Business Practice Location Address
First Line	:	15420 COLLIER BLVD
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34120
Country	:	US
Telephone Number	:	239-624-0600
Fax Number	:	239-624-0601

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	05/22/2018

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Directions to “ KAREN L HIESTER DO” Practice Location

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