Provider Demographics
NPI:1487815742
Name:BRACKE, RACHAEL M (MD)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:M
Last Name:BRACKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:MARIE
Other - Last Name:MCGINLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3030 BIG HORN AVE
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-9208
Mailing Address - Country:US
Mailing Address - Phone:307-578-1955
Mailing Address - Fax:307-578-1979
Practice Address - Street 1:3030 BIG HORN AVE
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-9208
Practice Address - Country:US
Practice Address - Phone:307-578-1955
Practice Address - Fax:307-578-1979
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL29717208M00000X
WY8977A208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04053391Medicaid
AL129285Medicaid
AL051117619OtherBCBS
WY133448400Medicaid
AL051117620OtherBCBS
AL129284Medicaid
AL129286Medicaid
AL051117618OtherBCBS
AL051117620OtherBCBS