Provider Demographics
NPI:1326222480
Name:DANIEL E KRACH MD PC
Entity Type:Organization
Organization Name:DANIEL E KRACH MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:KRACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:260-489-4656
Mailing Address - Street 1:2510 E DUPONT RD STE 128
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1603
Mailing Address - Country:US
Mailing Address - Phone:260-489-4656
Mailing Address - Fax:260-489-8280
Practice Address - Street 1:2510 E DUPONT RD STE 128
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1603
Practice Address - Country:US
Practice Address - Phone:260-489-4656
Practice Address - Fax:260-489-8280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0984220001Medicare NSC