Provider Demographics
NPI:1851344345
Name:KRAGH, REBECCA RAE (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:RAE
Last Name:KRAGH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3976 GOLFVIEW DR
Mailing Address - Street 2:
Mailing Address - City:JORDAN
Mailing Address - State:MN
Mailing Address - Zip Code:55352-8623
Mailing Address - Country:US
Mailing Address - Phone:952-492-5649
Mailing Address - Fax:952-492-5650
Practice Address - Street 1:3976 GOLFVIEW DR
Practice Address - Street 2:
Practice Address - City:JORDAN
Practice Address - State:MN
Practice Address - Zip Code:55352-8623
Practice Address - Country:US
Practice Address - Phone:952-492-5649
Practice Address - Fax:952-492-5650
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN35722207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine