Provider Demographics
NPI:1447293436
Name:KRATZER, JOHN KENT (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:KENT
Last Name:KRATZER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6920 POINTE INVERNESS WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7934
Mailing Address - Country:US
Mailing Address - Phone:260-479-3513
Mailing Address - Fax:
Practice Address - Street 1:107 W PICKWICK DR
Practice Address - Street 2:STE A
Practice Address - City:SYRACUSE
Practice Address - State:IN
Practice Address - Zip Code:46567-1832
Practice Address - Country:US
Practice Address - Phone:574-457-8585
Practice Address - Fax:574-457-8755
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02000948A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100159230Medicaid
IN100159230Medicaid
135510Medicare PIN
453220AMedicare PIN
IN262490JMedicare PIN