Active NPI
Karen Elizabeth Mack
- Contractor
- Miami, FL
National Provider Identifier
1770740409
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- KHU-0108-688-84
- Practice address
- 5275 SW 133Rd Ave
Miami, FL 33175-5231 - Phone
- (305) 227-4209
- Fax
- (305) 227-4209
- NPI assigned
- May 20, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | KHU-0108-688-84 | FL | Primary |
Addresses
Primary practice location
5275 SW 133Rd Ave
Miami, FL 33175-5231
Mailing address
5275 SW 133Rd Ave
Miami, FL 33175-5231
Phone (305) 227-4209
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 300096600 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| KHU-0108-688-84 | FL | MD | Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1211241600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211241600000",
"number": "1770740409",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5275 SW 133RD AVE",
"city": "MIAMI",
"state": "FL",
"postal_code": "331755231",
"telephone_number": "305-227-4209",
"fax_number": "305-227-4209"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5275 SW 133RD AVE",
"city": "MIAMI",
"state": "FL",
"postal_code": "331755231",
"telephone_number": "305-227-4209",
"fax_number": "305-227-4209"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACK",
"first_name": "KAREN",
"middle_name": "ELIZABETH",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-05-20",
"last_updated": "2008-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "FL",
"license": "KHU-0108-688-84",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "300096600",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Miami, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.