Healthcare Provider Details

I. General information

NPI: 1922462944
Provider Name (Legal Business Name): MIKAIL KRAFT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2016
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 NE 96TH ST
LIBERTY MO
64068-1316
US

IV. Provider business mailing address

1540 NE 96TH ST
LIBERTY MO
64068-1316
US

V. Phone/Fax

Practice location:
  • Phone: 816-412-2900
  • Fax:
Mailing address:
  • Phone: 816-412-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2019024458
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: