Provider Demographics
NPI:1346294121
Name:KRAFT, DANIEL E (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:E
Last Name:KRAFT
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 1:2605 N LEBANON ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:46052-1476
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2705 N LEBANON ST STE 210
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-8622
Practice Address - Country:US
Practice Address - Phone:765-485-8896
Practice Address - Fax:765-485-8795
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039565A2080S0010X, 2081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No2080S0010XAllopathic & Osteopathic PhysiciansPediatricsSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100382710Medicaid
IN100382710Medicare PIN
ININ1663027Medicare PIN
IN177280020Medicare PIN
IN266180370Medicare PIN
INM400018838Medicare PIN
IN100382710Medicaid
IN0208260001Medicare NSC
IN797310WMedicare PIN
INF42468Medicare UPIN
IN0208260001Medicare NSC
IN797310WMedicare PIN
INF42468Medicare UPIN