Healthcare Provider Details

I. General information

NPI: 1033127691
Provider Name (Legal Business Name): KRISHNAKANT RAIKER MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 06/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9038 COLUMBIA AVE SUITE B
MUNSTER IN
46321-2905
US

IV. Provider business mailing address

9038 COLUMBIA AVE SUITE B
MUNSTER IN
46321-2905
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-8106
  • Fax: 219-836-5774
Mailing address:
  • Phone: 219-836-8106
  • Fax: 219-836-5774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01047569
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036100077
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01042561
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036097164
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036097164
License Number StateIL
# 6
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number01042561
License Number StateIN

VIII. Authorized Official

Name: MRS. KRISTINE K VRANISKOSKI
Title or Position: OFFICE MANAGER
Credential:
Phone: 219-836-8106