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NPI Code Detail

MEDICARE: KAREN DIANE FARRIS DO

MEDICARE: KAREN DIANE FARRIS 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
1390200000XStudent in an Organized Health Care Education/Training Program
2207Q00000XFamily Medicine Physician02006114AIN

Other Identifiers

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

General Provider Information

NPI Number : 1568990083
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAREN DIANE FARRIS DO
Provider Business Mailing Address
First Line : 105 E LINCOLN AVE
Second Line :
City : LANCASTER
State : WI
Zip : 53813-2019
Country : US
Telephone Number : 608-723-3100
Fax Number : 866-560-8783
Provider Business Practice Location Address
First Line : 105 E LINCOLN AVE
Second Line :
City : LANCASTER
State : WI
Zip : 53813-2019
Country : US
Telephone Number : 608-723-3100
Fax Number : 866-560-8783
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/29/2017
Last Update Date : 05/07/2025

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