Healthcare Provider Details

I. General information

NPI: 1386814978
Provider Name (Legal Business Name): JESS KRAFT DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2008
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27920 ARLINGTON DR
SOUTHFIELD MI
48076-5605
US

IV. Provider business mailing address

27920 ARLINGTON DR
SOUTHFIELD MI
48076-5605
US

V. Phone/Fax

Practice location:
  • Phone: 248-353-1221
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number00661
License Number StateMI

VIII. Authorized Official

Name: DR. JESS KRAFT
Title or Position: PRESIDENT
Credential: DPM
Phone: 248-353-1221