Provider Demographics
NPI:1003801747
Name:HAAKE, KARL J (MD)
Entity type:Individual
Prefix:
First Name:KARL
Middle Name:J
Last Name:HAAKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 11521
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66207-4221
Mailing Address - Country:US
Mailing Address - Phone:913-261-9081
Mailing Address - Fax:913-261-9081
Practice Address - Street 1:1600 N 2ND ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MO
Practice Address - Zip Code:64735-1192
Practice Address - Country:US
Practice Address - Phone:913-261-9081
Practice Address - Fax:913-261-9081
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2002003282207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO050089107OtherRR MEDICARE
MO205804404Medicaid
MO205804404Medicaid
MOH31262Medicare UPIN