Provider Demographics
NPI:1114960408
Name:DRANCIK, JENNIFER (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:DRANCIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 N EAST ST
Mailing Address - Street 2:P.O. BOX 548
Mailing Address - City:WABASH
Mailing Address - State:IN
Mailing Address - Zip Code:46992-1914
Mailing Address - Country:US
Mailing Address - Phone:260-563-3131
Mailing Address - Fax:260-569-2375
Practice Address - Street 1:275 W 12TH ST
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IN
Practice Address - Zip Code:46970-1638
Practice Address - Country:US
Practice Address - Phone:765-472-8000
Practice Address - Fax:260-479-2917
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01070362A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100270190BMedicaid
IN201044240OtherMEDICARE
H34925Medicare UPIN