Provider Demographics
NPI:1689764045
Name:KRACHMER, JAY H (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:H
Last Name:KRACHMER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:420 DELAWARE ST SE MMC 493
Mailing Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-625-4400
Mailing Address - Fax:
Practice Address - Street 1:516 DELAWARE ST SE
Practice Address - Street 2:PWB NINTH FLOOR, CLINIC 9A
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0356
Practice Address - Country:US
Practice Address - Phone:612-625-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN35721207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0055522Medicaid
MN08-00043OtherMEDICA-PRIMARY
MN089169OtherFAIRVIEW
MN0134012OtherPREFERRED ONE
MN2T514KROtherBCBS
768207OtherARAZ
IA0906420Medicaid
MN101324OtherUCARE
MNHP13734OtherHEALTH PARTNERS
MN0825404OtherMEDICA-CHOICE
IA0906420Medicaid