Provider Demographics
NPI:1245299080
Name:PRAEGER, MARK A (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:PRAEGER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:330 ARKANSAS ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-1335
Mailing Address - Country:US
Mailing Address - Phone:785-505-2200
Mailing Address - Fax:785-505-2222
Practice Address - Street 1:330 ARKANSAS ST
Practice Address - Street 2:SUITE 202
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-1335
Practice Address - Country:US
Practice Address - Phone:785-505-2200
Practice Address - Fax:785-505-2222
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2014-05-20
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Provider Licenses
StateLicense IDTaxonomies
KS04-14233208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSB68393Medicare UPIN