Healthcare Provider Details

I. General information

NPI: 1114960408
Provider Name (Legal Business Name): JENNIFER DRANCIK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 09/14/2020
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 W 12TH ST
PERU IN
46970-1638
US

IV. Provider business mailing address

710 N EAST ST P.O. BOX 548
WABASH IN
46992-1914
US

V. Phone/Fax

Practice location:
  • Phone: 765-472-8000
  • Fax: 260-479-2917
Mailing address:
  • Phone: 260-563-3131
  • Fax: 260-569-2375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01070362A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: