Provider Demographics
NPI:1629067459
Name:KRAHN, MORTEN GREGG (DPM)
Entity Type:Individual
Prefix:DR
First Name:MORTEN
Middle Name:GREGG
Last Name:KRAHN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S DOBSON RD
Mailing Address - Street 2:#D-35
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5678
Mailing Address - Country:US
Mailing Address - Phone:480-732-0033
Mailing Address - Fax:480-732-0038
Practice Address - Street 1:600 S DOBSON RD
Practice Address - Street 2:#D-35
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5678
Practice Address - Country:US
Practice Address - Phone:480-732-0033
Practice Address - Fax:480-732-0038
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0563213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ779572Medicaid
AZ779572Medicaid
AZ79133Medicare PIN