Basic Information
| Provider Information | |||||||||
| NPI: | 1205026994 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FAGIN | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 673671 | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482673671 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8107205715 | ||||||||
| FaxNumber: | 8107320891 | ||||||||
| Practice Location | |||||||||
| Address1: | 4201 SAINT ANTOINE ST | ||||||||
| Address2: | UHC, SUITE 6A | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482012153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3137454230 | ||||||||
| FaxNumber: | 3137454298 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2007 | ||||||||
| LastUpdateDate: | 05/03/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | G44672 | CA | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | 47757 | GA | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | 4301086008 | MI | Y | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | 101037 | MT | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | 23004 | NE | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | 8300 | ND | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | MD19638 | OR | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | MD035158E | PA | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | 00038053 | WA | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | 6911A | WY | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | 015316 | ME | N | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.