MEDICARE: KARL J. HAAKE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician	2002003282	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	050089107	OTHER	MO	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003801747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARL J. HAAKE MD

Provider Business Mailing Address
First Line	:	PO BOX 11521
Second Line	:
City	:	SHAWNEE MISSION
State	:	KS
Zip	:	66207-4221
Country	:	US
Telephone Number	:	913-261-9081
Fax Number	:	913-261-9081

Provider Business Practice Location Address
First Line	:	1600 N 2ND ST
Second Line	:
City	:	CLINTON
State	:	MO
Zip	:	64735-1192
Country	:	US
Telephone Number	:	913-261-9081
Fax Number	:	913-261-9081

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	09/22/2016

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