Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 32897 | WI |
NPI | 1407901580 |
---|---|
Provider Name | Daniel R Kraeger |
First Address | Stevens Point, WI 54481 |
Second Address | Stevens Point, WI 54481 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2007 |
Last Update Date | 23/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
31877900 | (05) | WI |