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General NPI Number Information
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NPI Number | 1073582417
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Entity Type | Individual
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Provider Name | JESSE C. KRAKAUER MD
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Gender | Male
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Dates
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Enumeration Date | 03/17/2006
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Last Update Date | 01/24/2025
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Provider Practice Location Address
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Address Line | 2905 12 MILE RD
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City | BERKLEY
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State | MI
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Zip | 48072-1413
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Country | US
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Telephone | 248-541-0770
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Fax | 248-415-1672
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Provider Business Mailing Address
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Address Line | 2805 PONTIAC LAKE RD STE 2B
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City | WATERFORD
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State | MI
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Zip | 48328-2680
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Country | US
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Telephone | 248-541-0770
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Fax | 248-415-1672
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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 | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 4301043287
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License Number State | MI
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