MEDICARE: DR. KAREN NADINE CLISTER DDS

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	122300000X	Dentist	14250	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14250	OTHER	MI	MICHIGAN LICENSE NUMBER
2	014250	OTHER	MI	BCBS PROVIDER ID
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831180355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAREN NADINE CLISTER DDS

Provider Business Mailing Address
First Line	:	1220 E NAPIER AVE
Second Line	:
City	:	BENTON HARBOR
State	:	MI
Zip	:	49022-3900
Country	:	US
Telephone Number	:	269-925-2113
Fax Number	:	269-925-2191

Provider Business Practice Location Address
First Line	:	1220 E NAPIER AVE
Second Line	:
City	:	BENTON HARBOR
State	:	MI
Zip	:	49022-3900
Country	:	US
Telephone Number	:	269-925-2113
Fax Number	:	269-925-2191

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

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	07/09/2007

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