Provider Demographics
NPI:1083688568
Name:DRAKE, KAREN L (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:DRAKE
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 1:1440 PLEASANT ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314-1728
Mailing Address - Country:US
Mailing Address - Phone:515-241-8383
Mailing Address - Fax:515-241-8386
Practice Address - Street 1:1440 PLEASANT ST
Practice Address - Street 2:SUITE 1
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-1728
Practice Address - Country:US
Practice Address - Phone:515-241-8383
Practice Address - Fax:515-241-8386
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA31018207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0133546Medicaid
IA0133546Medicaid
IAI2217Medicare ID - Type Unspecified