Karen Lea Eldevick, MD

Primary specialty

Adult Medicine PhysicianTaxonomy code 207QA0505X

License

64279-20 Issued in WI

Practice address

2820 Roosevelt Road
Marinette, WI 54143-3834

Phone

(715) 735-5225

Fax

(715) 735-5388

NPI assigned

Nov 1, 2005

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Interoperability endpoints

• Direct secure messaging: keldevick163299@direct.thedacare.org

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541116800000",
    "number": "1962493718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1866",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543051866",
            "telephone_number": "920-445-7222",
            "fax_number": "920-445-7289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2820 ROOSEVELT ROAD",
            "city": "MARINETTE",
            "state": "WI",
            "postal_code": "541433834",
            "telephone_number": "715-735-5225",
            "fax_number": "715-735-5388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELDEVICK",
        "first_name": "KAREN",
        "middle_name": "LEA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-01",
        "last_updated": "2018-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "WI",
            "license": "64279-20",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301051670",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080036025",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2674383",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MICHIGAN",
            "identifier": "KE051670",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Janet Dunlap, PT, DPT
• Dragana Durdevic
• Paul Ebben, H.I.S.
• Jessica Ann Ecker, APNP
• Mohamed S El-Jack
• Jennifer Eldridge
• Khaled Elkady Hussein, M.D
• Robin Gerald Elsner, MSW LCSW
• Emergency Physician Associates of Wisconsin SC
• Emergency Rescue Squad Inc

• Adult Medicine Physician in Marinette, WI
• Providers in Marinette, WI by specialty
• Adult Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.