Provider Demographics
NPI:1679620470
Name:KRAKAUER, MARK M (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:M
Last Name:KRAKAUER
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 1:104 WOODMONT BLVD
Mailing Address - Street 2:SUITE LL50
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2245
Mailing Address - Country:US
Mailing Address - Phone:615-386-2300
Mailing Address - Fax:615-386-2399
Practice Address - Street 1:4230 HARDING RD
Practice Address - Street 2:SUITE 400
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2013
Practice Address - Country:US
Practice Address - Phone:615-297-2700
Practice Address - Fax:615-269-4584
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN42728207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN9726151OtherAETNA
TN1507300Medicaid
TN5537973OtherCIGNA
TN12702776OtherPHCS/MULTIPLAN
TNP00634255OtherMEDICARE RR
TN01228364OtherAMERIGROUP TNCARE ONLY
TN1100835730OtherUSA PPO/GEHA
KY7100077090Medicaid
TN1103297OtherUSA MCO
TN1920691OtherCOVENTRY
TN2904149OtherUNITED HEALTH CARE
TN4191997OtherBLUE CROSS
TN12702776OtherPHCS/MULTIPLAN
KY7100077090Medicaid