Basic Information
| Provider Information | |||||||||
| NPI: | 1679620470 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KRAKAUER | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 104 WOODMONT BLVD | ||||||||
| Address2: | SUITE LL50 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372052245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153862300 | ||||||||
| FaxNumber: | 6153862399 | ||||||||
| Practice Location | |||||||||
| Address1: | 4230 HARDING RD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372052013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152972700 | ||||||||
| FaxNumber: | 6152694584 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2007 | ||||||||
| LastUpdateDate: | 05/12/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 42728 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 42728 | TN | N | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 9726151 | 01 | TN | AETNA | OTHER | 1507300 | 05 | TN | MEDICAID | 5537973 | 01 | TN | CIGNA | OTHER | 12702776 | 01 | TN | PHCS/MULTIPLAN | OTHER | P00634255 | 01 | TN | MEDICARE RR | OTHER | 01228364 | 01 | TN | AMERIGROUP TNCARE ONLY | OTHER | 1100835730 | 01 | TN | USA PPO/GEHA | OTHER | 7100077090 | 05 | KY | MEDICAID | 1103297 | 01 | TN | USA MCO | OTHER | 1920691 | 01 | TN | COVENTRY | OTHER | 2904149 | 01 | TN | UNITED HEALTH CARE | OTHER | 4191997 | 01 | TN | BLUE CROSS | OTHER |