Provider Demographics
NPI:1376509984
Name:KRAKE, PATRICK RAYMOND (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:RAYMOND
Last Name:KRAKE
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 1:1111 MEDICAL CENTER BLVD
Mailing Address - Street 2:N613
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3151
Mailing Address - Country:US
Mailing Address - Phone:504-349-6800
Mailing Address - Fax:504-349-6621
Practice Address - Street 1:1111 MEDICAL CENTER BLVD
Practice Address - Street 2:N613
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3151
Practice Address - Country:US
Practice Address - Phone:504-349-6800
Practice Address - Fax:504-349-6621
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA24287207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1570052Medicaid
LAH27346Medicare UPIN
LA5C399Medicare ID - Type Unspecified