Provider Demographics
NPI:1417129248
Name:GREGG KRAHN DPM PC
Entity Type:Organization
Organization Name:GREGG KRAHN DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MORTEN
Authorized Official - Middle Name:GREGG
Authorized Official - Last Name:KRAHN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:480-358-6090
Mailing Address - Street 1:132 W JASPER DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-8327
Mailing Address - Country:US
Mailing Address - Phone:480-358-6090
Mailing Address - Fax:480-917-1295
Practice Address - Street 1:1301 S CRISMON RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-3767
Practice Address - Country:US
Practice Address - Phone:480-358-6090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0563213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00251719OtherMEDICARE RAILROAD
AZ00700478Medicaid
AZU92114Medicare UPIN
AZ00700478Medicaid
AZZ121436Medicare PIN