Basic Information
| Provider Information | |||||||||
| NPI: | 1003836214 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOOLPE | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1640 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | SANTA FE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 875054754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059839350 | ||||||||
| FaxNumber: | 5059558763 | ||||||||
| Practice Location | |||||||||
| Address1: | 1640 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | SANTA FE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 875054754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059839350 | ||||||||
| FaxNumber: | 5059558763 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 03/18/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | MD2006-0152 | NM | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 49733826 | 05 | NM | MEDICAID |