Provider Demographics
NPI:1750415154
Name:KRAGT, DANIEL NELSON (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:NELSON
Last Name:KRAGT
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 1:501 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-3927
Mailing Address - Country:US
Mailing Address - Phone:574-534-6159
Mailing Address - Fax:
Practice Address - Street 1:1155 N 1200 W
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:IN
Practice Address - Zip Code:46540-9372
Practice Address - Country:US
Practice Address - Phone:574-825-3888
Practice Address - Fax:574-825-3999
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045077A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ING25268Medicare UPIN