Provider Demographics
NPI:1972554384
Name:KRAKER, DAVID P (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:P
Last Name:KRAKER
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 1:8232 HIGHWAY 65 NE
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55432-2095
Mailing Address - Country:US
Mailing Address - Phone:763-577-1877
Mailing Address - Fax:763-577-1887
Practice Address - Street 1:8232 HIGHWAY 65 NE
Practice Address - Street 2:
Practice Address - City:SPRING LAKE PARK
Practice Address - State:MN
Practice Address - Zip Code:55432-2095
Practice Address - Country:US
Practice Address - Phone:763-577-1877
Practice Address - Fax:763-577-1887
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN35945207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN38Q21KROtherBLUE CROSS BLUE SHIELD
MN485072600Medicaid
MNHP13737OtherHEALTH PARTNERS
MN0907745OtherMEDICA
MN115118OtherUCARE
MN200033761OtherRAILROAD MEDICARE
MN23959OtherARAZ
MN936130496008OtherPREFERRED ONE
MN0907745OtherMEDICA
MN115118OtherUCARE
MND93574Medicare UPIN