Healthcare Provider Details

I. General information

NPI: 1194722934
Provider Name (Legal Business Name): DAVID KRACKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 W NORTH AVE STE 402
MELROSE PARK IL
60160-1624
US

IV. Provider business mailing address

120 W 22ND ST STE 200
OAK BROOK IL
60523-1563
US

V. Phone/Fax

Practice location:
  • Phone: 708-450-4551
  • Fax:
Mailing address:
  • Phone: 630-573-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number036104149
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: