Provider Demographics
NPI:1164415519
Name:KRASKE, GERHARD KARL (MD)
Entity Type:Individual
Prefix:
First Name:GERHARD
Middle Name:KARL
Last Name:KRASKE
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 1:202 S PARK ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1507
Mailing Address - Country:US
Mailing Address - Phone:608-417-3434
Mailing Address - Fax:
Practice Address - Street 1:7780 ELMWOOD AVE.
Practice Address - Street 2:SUITE 201
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-5407
Practice Address - Country:US
Practice Address - Phone:608-417-3434
Practice Address - Fax:608-828-3444
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101240703207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG19676Medicare UPIN