Basic Information
| Provider Information | |||||||||
| NPI: | 1720176308 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KARACHUNSKI | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | I | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2450 RIVERSIDE AVE SE | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554541450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123656777 | ||||||||
| FaxNumber: | 6123658021 | ||||||||
| Practice Location | |||||||||
| Address1: | 2450 RIVERSIDE AVE SE | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554555545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123656777 | ||||||||
| FaxNumber: | 6123658021 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2006 | ||||||||
| LastUpdateDate: | 10/04/2017 | ||||||||
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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 | 2084P0804X | 47339 | MN | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 05-00144 | 01 | MEDICA-PRIMARY | OTHER | 2378185 | 01 | ARAZ | OTHER | C002 | 01 | CHAMPUS | OTHER | HP54585 | 01 | HEALTH PARTNERS | OTHER | 497K2KA | 01 | MN | BLUE CROSS BLUE SHIELD | OTHER | 05-00682 | 01 | MEDICA-CHOICE | OTHER | 1044949 | 01 | PREFERRED ONE | OTHER | 135153 | 01 | U CARE | OTHER | 0144625 | 05 | MT | MEDICAID | 0595983 | 05 | IA | MEDICAID | 23954-1 | 01 | FAIRVIEW CAREGIVER ID | OTHER | 34668100 | 05 | WI | MEDICAID |