Healthcare Provider Details

I. General information

NPI: 1407901580
Provider Name (Legal Business Name): DANIEL R KRAEGER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 ILLINOIS AVENUE
STEVENS POINT WI
54481
US

IV. Provider business mailing address

900 ILLINOIS AVENUE
STEVENS POINT WI
54481
US

V. Phone/Fax

Practice location:
  • Phone: 715-342-7500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number32897
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: