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General NPI Number Information
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NPI Number | 1013702182
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Entity Type | Individual
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Provider Name | MR. JACOB DYLAN KRAUS
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Gender | Male
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Dates
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Enumeration Date | 04/10/2025
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Last Update Date | 11/25/2025
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Provider Practice Location Address
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Address Line | 6092 MAYFIELD RD
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City | MAYFIELD HEIGHTS
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State | OH
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Zip | 44124-3225
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Country | US
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Telephone | 440-462-4677
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Fax |
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Provider Business Mailing Address
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Address Line | 8779 CHINABERRY CIR N
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City | MACEDONIA
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State | OH
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Zip | 44056-2328
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Country | US
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Telephone | 440-666-7530
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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