Provider Demographics
NPI:1073564423
Name:BRASEL, KAREN J (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:J
Last Name:BRASEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3181 SW SAM JACKSON PARK RD # L223
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3011
Mailing Address - Country:US
Mailing Address - Phone:503-494-7344
Mailing Address - Fax:503-494-5615
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD # L223
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-494-7344
Practice Address - Fax:503-494-5615
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD1698382086S0127X
WI410392086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32550200Medicaid
003000215UOtherHUMANA
WI1073564423Medicaid
WI32550200Medicaid
G92202Medicare UPIN