Healthcare Provider Details

I. General information

NPI: 1710958673
Provider Name (Legal Business Name): DIANA MARIE KRAFT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 HEALTH SERVICES DR SUITE 4
DEKALB IL
60115-9647
US

IV. Provider business mailing address

331 GREENWOOD ACRES DR
DEKALB IL
60115
US

V. Phone/Fax

Practice location:
  • Phone: 815-748-8334
  • Fax: 815-748-8921
Mailing address:
  • Phone: 815-748-5175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: