Provider Demographics
NPI:1710186671
Name:FLASKA, CORINNE M (DO)
Entity Type:Individual
Prefix:
First Name:CORINNE
Middle Name:M
Last Name:FLASKA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CORINNE
Other - Middle Name:M
Other - Last Name:RIDENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:105 FAR WEST DR.,
Mailing Address - Street 2:STE. 100
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-3514
Mailing Address - Country:US
Mailing Address - Phone:816-271-8115
Mailing Address - Fax:816-270-8104
Practice Address - Street 1:105 FAR WEST DR.,
Practice Address - Street 2:STE. 100
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-3514
Practice Address - Country:US
Practice Address - Phone:816-271-8100
Practice Address - Fax:816-270-8104
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006015227207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00688411OtherRR MEDICARE
MO1710186671Medicaid
KS200477790BMedicaid
MOP00688411OtherRR MEDICARE
F29F527AMedicare Oscar/Certification