Provider Demographics
NPI:1174733224
Name:WIARDA, KAREN PHYLIS (DO)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:PHYLIS
Last Name:WIARDA
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:WIARDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:611 W PARK ST
Mailing Address - Street 2:BWPC
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:217-383-4752
Practice Address - Street 1:100 LERNA RD S
Practice Address - Street 2:CARDIOVASCULAR AND THORACIC SURGERY
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-9384
Practice Address - Country:US
Practice Address - Phone:217-904-7000
Practice Address - Fax:217-904-7748
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016549207R00000X, 207RC0001X
GA071651207RC0000X
IL036140067207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology