Provider Demographics
NPI:1720176308
Name:KARACHUNSKI, PETER I (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:I
Last Name:KARACHUNSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 RIVERSIDE AVE SE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1450
Mailing Address - Country:US
Mailing Address - Phone:612-365-6777
Mailing Address - Fax:612-365-8021
Practice Address - Street 1:2450 RIVERSIDE AVE SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-5545
Practice Address - Country:US
Practice Address - Phone:612-365-6777
Practice Address - Fax:612-365-8021
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN473392084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
05-00144OtherMEDICA-PRIMARY
2378185OtherARAZ
C002OtherCHAMPUS
HP54585OtherHEALTH PARTNERS
MN497K2KAOtherBLUE CROSS BLUE SHIELD
05-00682OtherMEDICA-CHOICE
1044949OtherPREFERRED ONE
135153OtherU CARE
MT0144625Medicaid
IA0595983Medicaid
23954-1OtherFAIRVIEW CAREGIVER ID
WI34668100Medicaid
05-00682OtherMEDICA-CHOICE
MN497K2KAOtherBLUE CROSS BLUE SHIELD
MN130001231Medicare ID - Type Unspecified