MEDICARE: DANIEL KARRELS

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
1	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1740658418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL KARRELS

Provider Business Mailing Address
First Line	:	1540 PINE CONE TRL
Second Line	:
City	:	PORT WASHINGTON
State	:	WI
Zip	:	53074-2634
Country	:	US
Telephone Number	:	262-305-6187
Fax Number	:

Provider Business Practice Location Address
First Line	:	1540 PINE CONE TRL
Second Line	:
City	:	PORT WASHINGTON
State	:	WI
Zip	:	53074-2634
Country	:	US
Telephone Number	:	262-305-6187
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2015
Last Update Date	:	05/16/2016

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