Healthcare Provider Details

I. General information

NPI: 1437296787
Provider Name (Legal Business Name): RICHARD KRAFT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 6TH ST E BOX 879
MCLAUGHLIN SD
57642-0879
US

IV. Provider business mailing address

701 6TH ST E BOX 879
MCLAUGHLIN SD
57642-0879
US

V. Phone/Fax

Practice location:
  • Phone: 605-823-4458
  • Fax: 605-823-4470
Mailing address:
  • Phone: 605-823-4458
  • Fax: 605-823-4470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4157
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: