Healthcare Provider Details

I. General information

NPI: 1710039516
Provider Name (Legal Business Name): MARK E KRAYNAK ACSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3340 HOSPITAL RD
SAGINAW MI
48603-9622
US

IV. Provider business mailing address

3340 HOSPITAL RD
SAGINAW MI
48603-9622
US

V. Phone/Fax

Practice location:
  • Phone: 989-790-7700
  • Fax: 989-964-5008
Mailing address:
  • Phone: 989-790-7700
  • Fax: 989-964-5008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberMK065692
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: