Provider Demographics
NPI:1033370622
Name:HARTER, RACHAEL M (DO)
Entity Type:Individual
Prefix:DR
First Name:RACHAEL
Middle Name:M
Last Name:HARTER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7907 POWERS BLVD
Mailing Address - Street 2:RIDGEVIEW CHANHASSEN CLINIC
Mailing Address - City:CHANHASSEN
Mailing Address - State:MN
Mailing Address - Zip Code:55317-9502
Mailing Address - Country:US
Mailing Address - Phone:952-934-0570
Mailing Address - Fax:
Practice Address - Street 1:7907 POWERS BLVD
Practice Address - Street 2:RIDGEVIEW CHANHASSEN CLINIC
Practice Address - City:CHANHASSEN
Practice Address - State:MN
Practice Address - Zip Code:55317-9502
Practice Address - Country:US
Practice Address - Phone:952-934-0570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE713207R00000X
MN59908207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
391627Medicare UPIN