Healthcare Provider Details

I. General information

NPI: 1952458754
Provider Name (Legal Business Name): PAMELA M. KRATKOCZKI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HENRY FORD HEALTH SYSTEM 19401 HUBBARD DRIVE
DEARBORN MI
48126
US

IV. Provider business mailing address

HENRY FORD HEALTH SYSTEM 19401 HUBBARD DRIVE
DEARBORN MI
48126
US

V. Phone/Fax

Practice location:
  • Phone: 313-982-8330
  • Fax: 313-982-8294
Mailing address:
  • Phone: 313-982-8330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301048924
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: