Provider Demographics
NPI:1528041472
Name:GRAESSLE, DONNA MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:MARIE
Last Name:GRAESSLE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10200 W 105TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-5750
Mailing Address - Country:US
Mailing Address - Phone:913-495-9600
Mailing Address - Fax:913-599-0951
Practice Address - Street 1:10200 W 105TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-5750
Practice Address - Country:US
Practice Address - Phone:913-495-9600
Practice Address - Fax:913-599-0951
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0526237207RG0100X
MOR7J11207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS2456436903Medicaid
E79286Medicare UPIN