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General NPI Number Information
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NPI Number | 1558959403
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Entity Type | Individual
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Provider Name | JACOB CRAZE NP
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Gender | Male
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Dates
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Enumeration Date | 01/06/2021
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Last Update Date | 12/25/2025
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Provider Practice Location Address
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Address Line | 30700 TELEGRAPH RD STE 15401
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City | BINGHAM FARMS
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State | MI
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Zip | 48025-4524
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Country | US
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Telephone | 313-800-8230
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Fax | 866-516-0753
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Provider Business Mailing Address
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Address Line | 18302 MIDDLEBELT RD
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City | LIVONIA
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State | MI
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Zip | 48152-5007
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Country | US
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Telephone | 248-478-1500
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Fax | 248-478-2798
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704340387
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License Number State | MI
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