Provider Demographics
NPI:1700855871
Name:STRACK, KAREN (DO)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:
Last Name:STRACK
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 1:513 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:IL
Mailing Address - Zip Code:62906-1668
Mailing Address - Country:US
Mailing Address - Phone:618-833-4471
Mailing Address - Fax:618-833-6267
Practice Address - Street 1:513 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:IL
Practice Address - Zip Code:62906-1668
Practice Address - Country:US
Practice Address - Phone:618-833-4471
Practice Address - Fax:618-833-6267
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036059507207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036059507Medicaid
IL46374OtherGHP INSURANCE #
IL080061809OtherRAILROAD MEDICARE #
IL102355OtherHEALTHLINK INSURANCE #
IL027545OtherHAMP INSURANCE #
ILC39873Medicare UPIN
IL46374OtherGHP INSURANCE #