Individual
DR. KEITH BRYAN DANCKAERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4020 NEW VISION DR, FORT WAYNE, IN 46845-1737
(260) 423-2567
(260) 420-2415
Mailing address
801 YORK ST, MANITOWOC, WI 54220-4630
(920) 663-9016
(920) 684-1439
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
01042415A
IN
207ND0101X
MOHS-Micrographic Surgery Physician
01042415A
IN
Other
Enumeration date
07/07/2006
Last updated
02/16/2021
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