Provider Demographics
NPI:1306806302
Name:KRACH, DANIEL EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:EDWARD
Last Name:KRACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DANIEL
Other - Middle Name:EDWARD
Other - Last Name:KRACH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2510 E DUPONT RD STE 128
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1603
Mailing Address - Country:US
Mailing Address - Phone:260-489-4656
Mailing Address - Fax:260-489-8280
Practice Address - Street 1:2510 E DUPONT RD STE 128
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1603
Practice Address - Country:US
Practice Address - Phone:260-489-4656
Practice Address - Fax:260-489-8280
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036895207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100318780FMedicaid
INE84637Medicare UPIN
IN100318780FMedicaid