Provider Demographics
NPI:1487607313
Name:KRIVACH, JUNE DENISE (MD)
Entity type:Individual
Prefix:
First Name:JUNE
Middle Name:DENISE
Last Name:KRIVACH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1221 NICOLLET AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-2420
Mailing Address - Country:US
Mailing Address - Phone:612-573-2232
Mailing Address - Fax:612-573-2274
Practice Address - Street 1:1221 NICOLLET AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-2420
Practice Address - Country:US
Practice Address - Phone:612-573-2232
Practice Address - Fax:612-573-2274
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN376542085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34403000Medicaid
IA0555680Medicaid
MN108193OtherUCARE
MN300125698OtherRAILROAD MEDICARE MN
MN9203335OtherDAKOTA CARE
MN895555OtherAMERICA'S PPO
MN188051200Medicaid
MN61G86KROtherBLUE CROSS
MNHP34188OtherHEALTHPARTNERS
MN1017582OtherPREFERRED ONE
MN24853OtherMIDLANDS CHOICE INC
MN51G97KROtherBLUE CROSS
WI004004070Medicare PIN
MN188051200Medicaid
MN1017582OtherPREFERRED ONE
MN895555OtherAMERICA'S PPO
MN108193OtherUCARE
MNE70160Medicare UPIN