Healthcare Provider Details

I. General information

NPI: 1548853443
Provider Name (Legal Business Name): JESSICA ANNE KRAKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2021
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 N 87TH ST
MILWAUKEE WI
53226-4812
US

IV. Provider business mailing address

925 N 87TH ST
MILWAUKEE WI
53226-4812
US

V. Phone/Fax

Practice location:
  • Phone: 414-955-2020
  • Fax: 414-805-4818
Mailing address:
  • Phone: 414-955-2020
  • Fax: 414-805-4818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberDR.0074905
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number87435-020
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number31519
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number72127
License Number StateMN
# 5
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberDR.0074905
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: