MEDICARE: DR. PHILLIP L KRAFT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	4301044050	MI
2	207RI0011X	Interventional Cardiology Physician	4301044050	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811995699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILLIP L KRAFT M.D.

Provider Business Mailing Address
First Line	:	1701 SOUTH BLVD E
Second Line	:	SUITE 390
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-6117
Country	:	US
Telephone Number	:	248-293-0055
Fax Number	:	248-293-3348

Provider Business Practice Location Address
First Line	:	1701 SOUTH BLVD E
Second Line	:	#390
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-6117
Country	:	US
Telephone Number	:	248-293-0055
Fax Number	:	248-293-3348

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	10/22/2020

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