MEDICARE: MS. TRACY JEAN KARINEN 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
1	363AM0700X	Medical Physician Assistant	5601005240	MI

General Provider Information

NPI Number	:	1659532737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TRACY JEAN KARINEN PA-C

Provider Business Mailing Address
First Line	:	1701 SOUTH BLVD E STE 300
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-6120
Country	:	US
Telephone Number	:	248-844-9710
Fax Number	:

Provider Business Practice Location Address
First Line	:	37000 GRAND RIVER AVE STE 310
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48335-2868
Country	:	US
Telephone Number	:	248-536-2127
Fax Number	:

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

Provider Enumeration Date	:	06/20/2008
Last Update Date	:	01/03/2024

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