Healthcare Provider Details

I. General information

NPI: 1790759801
Provider Name (Legal Business Name): JENIFER ELIZABETH KRAUSE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENIFER ELIZABETH KRAUSE-PIERCE

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 WEALTHY ST SE MC 426
GRAND RAPIDS MI
49506-2921
US

IV. Provider business mailing address

36115 SCHOOLCRAFT RD
LIVONIA MI
48150-1216
US

V. Phone/Fax

Practice location:
  • Phone: 616-774-5221
  • Fax: 616-774-5391
Mailing address:
  • Phone: 764-464-0887
  • Fax: 719-402-0254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301057865
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: