Basic Information
| Provider Information | |||||||||
| NPI: | 1689764045 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KRACHMER | ||||||||
| FirstName: | JAY | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 420 DELAWARE ST SE MMC 493 | ||||||||
| Address2: | UNIVERSITY OF MINNESOTA PHYSICIANS | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6126254400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 516 DELAWARE ST SE | ||||||||
| Address2: | PWB NINTH FLOOR, CLINIC 9A | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554550356 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6126254400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 207W00000X | 35721 | MN | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 0055522 | 05 | MT | MEDICAID | 08-00043 | 01 | MN | MEDICA-PRIMARY | OTHER | 089169 | 01 | MN | FAIRVIEW | OTHER | 0134012 | 01 | MN | PREFERRED ONE | OTHER | 2T514KR | 01 | MN | BCBS | OTHER | 768207 | 01 | ARAZ | OTHER | 0906420 | 05 | IA | MEDICAID | 101324 | 01 | MN | UCARE | OTHER | HP13734 | 01 | MN | HEALTH PARTNERS | OTHER | 0825404 | 01 | MN | MEDICA-CHOICE | OTHER |