Provider Demographics
NPI:1568990083
Name:FARRIS, KAREN DIANE (DO)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:DIANE
Last Name:FARRIS
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 E LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:WI
Mailing Address - Zip Code:53813-2019
Mailing Address - Country:US
Mailing Address - Phone:608-723-3100
Mailing Address - Fax:866-560-8783
Practice Address - Street 1:105 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:WI
Practice Address - Zip Code:53813-2019
Practice Address - Country:US
Practice Address - Phone:608-723-3100
Practice Address - Fax:866-560-8783
Is Sole Proprietor?:No
Enumeration Date:2017-05-29
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IN02006114A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300043033Medicaid