Provider Demographics
NPI:1740498609
Name:KURICA, DANIEL KRAFT (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:KRAFT
Last Name:KURICA
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 1:370 BELLE TERRE BLVD
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-2435
Mailing Address - Country:US
Mailing Address - Phone:985-652-6066
Mailing Address - Fax:985-652-6063
Practice Address - Street 1:370 BELLE TERRE BLVD
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-2435
Practice Address - Country:US
Practice Address - Phone:985-652-6066
Practice Address - Fax:985-652-6063
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200934207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1091014Medicaid