Provider Demographics
NPI:1154316800
Name:KRAGENBRINK, DAVID E (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:KRAGENBRINK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 DELHI ST
Mailing Address - Street 2:SUITE 3500
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-6321
Mailing Address - Country:US
Mailing Address - Phone:563-557-5911
Mailing Address - Fax:563-557-5910
Practice Address - Street 1:1500 DELHI ST
Practice Address - Street 2:SUITE 3500
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-6321
Practice Address - Country:US
Practice Address - Phone:563-557-5911
Practice Address - Fax:563-557-5910
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA30061208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA16783OtherWELLMARK BCBS
IA3116665Medicaid
IA3116665Medicaid
IAP00010010Medicare PIN
IA16783OtherWELLMARK BCBS