Healthcare Provider Details

I. General information

NPI: 1659670461
Provider Name (Legal Business Name): NEAL J KRUMAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2011
Last Update Date: 07/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20176 LIVERNOIS AVE
DETROIT MI
48221-1346
US

IV. Provider business mailing address

4449 WOODRIDGE CT
WATERFORD MI
48328-4277
US

V. Phone/Fax

Practice location:
  • Phone: 313-864-7385
  • Fax: 313-864-7432
Mailing address:
  • Phone: 248-681-9677
  • Fax: 248-681-9678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5901000542
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: