Healthcare Provider Details

I. General information

NPI: 1093718827
Provider Name (Legal Business Name): JOEL D KRAKAUER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3515 GLENWOOD AVE
RALEIGH NC
27612-4934
US

IV. Provider business mailing address

3515 GLENWOOD AVE
RALEIGH NC
27612-4934
US

V. Phone/Fax

Practice location:
  • Phone: 919-781-5600
  • Fax: 919-782-6578
Mailing address:
  • Phone: 919-781-5600
  • Fax: 919-782-6578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number000640
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: