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General NPI Number Information
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NPI Number | 1114234440
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Entity Type | Individual
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Provider Name | DANIEL ROBERT KRAUCHUK D.O.
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Gender | Male
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Dates
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Enumeration Date | 09/08/2010
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Last Update Date | 12/29/2023
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Provider Practice Location Address
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Address Line | 9555 S EASTERN AVE STE 290
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City | LAS VEGAS
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State | NV
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Zip | 89123-8009
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Country | US
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Telephone | 702-870-3722
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Fax | 725-777-1304
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Provider Business Mailing Address
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Address Line | 1101 BAYSIDE DR
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City | CORONA DEL MAR
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State | CA
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Zip | 92625-1702
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Country | US
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Telephone | 833-753-3435
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Fax | 725-777-1304
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 5101016276
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 2865
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 20A11543
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License Number State | CA
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