MEDICARE: WILLIAM I KRACKE MD PA

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	2084P0800X	Psychiatry Physician	D3303	TX

General Provider Information

NPI Number	:	1801153119
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM I KRACKE MD PA

Provider Business Mailing Address
First Line	:	1705 S POLK ST
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79102-3152
Country	:	US
Telephone Number	:	806-374-6368
Fax Number	:	806-374-3550

Provider Business Practice Location Address
First Line	:	1705 S POLK ST
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79102-3152
Country	:	US
Telephone Number	:	806-374-6368
Fax Number	:	806-374-3550

Authorized Official
Title or Position	:	OWNER
Name	:	DR. WILLIAM I KRACKE
Credential	:	M.D.
Telephone Number	:	806-374-6368

Provider Enumeration Date	:	04/12/2012
Last Update Date	:	04/12/2012

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