Healthcare Provider Details

I. General information

NPI: 1811995699
Provider Name (Legal Business Name): PHILLIP L KRAFT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 10/22/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 SOUTH BLVD E #390
ROCHESTER HILLS MI
48307-6117
US

IV. Provider business mailing address

1701 SOUTH BLVD E SUITE 390
ROCHESTER HILLS MI
48307-6117
US

V. Phone/Fax

Practice location:
  • Phone: 248-293-0055
  • Fax: 248-293-3348
Mailing address:
  • Phone: 248-293-0055
  • Fax: 248-293-3348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301044050
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number4301044050
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: