Provider Demographics
NPI:1144268889
Name:BRAKE, KAREN T (MD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:T
Last Name:BRAKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:T
Other - Last Name:GASICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 13059
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4021
Mailing Address - Country:US
Mailing Address - Phone:317-583-3022
Mailing Address - Fax:317-583-2199
Practice Address - Street 1:100 ST MARYS EPWORTH XING
Practice Address - Street 2:STE A300
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-9497
Practice Address - Country:US
Practice Address - Phone:812-485-7752
Practice Address - Fax:812-485-7753
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01043338A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN20030580Medicaid
INF96546Medicare UPIN
IN20030580Medicaid
0000000596805OtherANTHEM