Basic Information
| Provider Information | |||||||||
| NPI: | 1487607313 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KRIVACH | ||||||||
| FirstName: | JUNE | ||||||||
| MiddleName: | DENISE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1221 NICOLLET AVE | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554032420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6125732232 | ||||||||
| FaxNumber: | 6125732274 | ||||||||
| Practice Location | |||||||||
| Address1: | 1221 NICOLLET AVE | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554032420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6125732232 | ||||||||
| FaxNumber: | 6125732274 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 07/02/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 37654 | MN | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 34403000 | 05 | WI | MEDICAID | 0555680 | 05 | IA | MEDICAID | 108193 | 01 | MN | UCARE | OTHER | 300125698 | 01 | MN | RAILROAD MEDICARE MN | OTHER | 9203335 | 01 | MN | DAKOTA CARE | OTHER | 895555 | 01 | MN | AMERICA'S PPO | OTHER | 188051200 | 05 | MN | MEDICAID | 61G86KR | 01 | MN | BLUE CROSS | OTHER | HP34188 | 01 | MN | HEALTHPARTNERS | OTHER | 1017582 | 01 | MN | PREFERRED ONE | OTHER | 24853 | 01 | MN | MIDLANDS CHOICE INC | OTHER | 51G97KR | 01 | MN | BLUE CROSS | OTHER |