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NPI Code Detail

MEDICARE: DR. GARY LOUIS KRAKER DO

MEDICARE: DR. GARY LOUIS KRAKER DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician34.007465OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1669439063
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GARY LOUIS KRAKER DO
Provider Business Mailing Address
First Line : 527 N MERIDIAN RD
Second Line :
City : YOUNGSTOWN
State : OH
Zip : 44509-1227
Country : US
Telephone Number : 330-797-0070
Fax Number :
Provider Business Practice Location Address
First Line : 320 HIGH ST NE
Second Line :
City : WARREN
State : OH
Zip : 44481-1222
Country : US
Telephone Number : 330-797-0070
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2006
Last Update Date : 09/26/2024

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