Provider Demographics
NPI:1437296787
Name:KRAFT, RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
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 1:701 6TH ST E
Mailing Address - Street 2:BOX 879
Mailing Address - City:MCLAUGHLIN
Mailing Address - State:SD
Mailing Address - Zip Code:57642-0879
Mailing Address - Country:US
Mailing Address - Phone:605-823-4458
Mailing Address - Fax:605-823-4470
Practice Address - Street 1:701 6TH ST E
Practice Address - Street 2:BOX 879
Practice Address - City:MCLAUGHLIN
Practice Address - State:SD
Practice Address - Zip Code:57642-0879
Practice Address - Country:US
Practice Address - Phone:605-823-4458
Practice Address - Fax:605-823-4470
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4157207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD8HZD79Medicare PIN