Individual
KAREN LEA ELDEVICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2820 ROOSEVELT ROAD, MARINETTE, WI 54143-3834
(715) 735-5225
(715) 735-5388
Mailing address
PO BOX 1866, GREEN BAY, WI 54305-1866
(920) 445-7222
(920) 445-7289
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
4301051670
MI
207QA0505X
Adult Medicine Physician
Primary
64279-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080036025
RAILROAD MEDICARE
MI
05
—
2674383
—
MI
01
—
KE051670
BCBS OF MICHIGAN
MI
Enumeration date
11/01/2005
Last updated
11/02/2018
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