Provider Demographics
NPI:1033127691
Name:KRISHNAKANT RAIKER MD PC
Entity Type:Organization
Organization Name:KRISHNAKANT RAIKER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:K
Authorized Official - Last Name:VRANISKOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-836-8106
Mailing Address - Street 1:9038 COLUMBIA AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2905
Mailing Address - Country:US
Mailing Address - Phone:219-836-8106
Mailing Address - Fax:219-836-5774
Practice Address - Street 1:9038 COLUMBIA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2905
Practice Address - Country:US
Practice Address - Phone:219-836-8106
Practice Address - Fax:219-836-5774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01047569207Q00000X
IL036100077207Q00000X
IN01042561207R00000X, 207RC0000X
IL036097164207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200835220AMedicaid
INDF2414OtherRAILROAD MEDICARE
IN237870Medicare PIN