Provider Demographics
NPI:1558372359
Name:KREIDER, DAN F (MD)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:F
Last Name:KREIDER
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 1:111 OAKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:EAST PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61611-1853
Mailing Address - Country:US
Mailing Address - Phone:309-740-4272
Mailing Address - Fax:
Practice Address - Street 1:2845 GREENBRIER RD
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-6519
Practice Address - Country:US
Practice Address - Phone:920-288-4848
Practice Address - Fax:920-288-4956
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI647392085R0202X
CO422912085R0202X
IL036-1591392085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100050366Medicaid
CO86678353Medicaid
COC801369Medicare PIN
COC809549Medicare PIN
COC528388Medicare PIN
COC803975Medicare PIN
COC801370Medicare PIN
COC810660Medicare PIN
COE86020Medicare UPIN
COCO400064Medicare PIN