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NPI Code Detail

MEDICARE: MISS KAREN ANN HAM PA-C

MEDICARE: MISS KAREN ANN HAM PA-C
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
1363A00000XPhysician Assistant085-002608IL

General Provider Information

NPI Number : 1629285515
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS KAREN ANN HAM PA-C
Provider Business Mailing Address
First Line : 4315 MEMORIAL DR
Second Line :
City : BELLEVILLE
State : IL
Zip : 62226-5342
Country : US
Telephone Number : 618-257-6220
Fax Number :
Provider Business Practice Location Address
First Line : 4315 MEMORIAL DR
Second Line :
City : BELLEVILLE
State : IL
Zip : 62226-5342
Country : US
Telephone Number : 618-257-6220
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2007
Last Update Date : 02/22/2021

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Directions to “ MISS KAREN ANN HAM PA-C” Practice Location

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