MEDICARE: DR. KAREN BENEDICTE LARSEN MD

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	207ZP0105X	Clinical Pathology/Laboratory Medicine Physician	46238	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1040004	OTHER	PREFERREDONE
5	11-00014	OTHER	MEDICA - PRIMARY
6	2032911	OTHER	ARAZ
7	HP40145	OTHER	HEALTHPARTNERS
8	11-00380	OTHER	MEDICA - CHOICE
9	131144	OTHER	UCARE
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770654279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAREN BENEDICTE LARSEN MD

Provider Business Mailing Address
First Line	:	402 COUNTY ROAD D W
Second Line	:	MEDTOX LABORATORIES, INC.
City	:	SAINT PAUL
State	:	MN
Zip	:	55112-3522
Country	:	US
Telephone Number	:	651-628-6115
Fax Number	:

Provider Business Practice Location Address
First Line	:	402 COUNTY ROAD D W
Second Line	:	MEDTOX LABORATORIES, INC.
City	:	SAINT PAUL
State	:	MN
Zip	:	55112-3522
Country	:	US
Telephone Number	:	651-628-6115
Fax Number	:

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

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	01/05/2009

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