Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 4301064003 | MI |
NPI | 1033546122 |
---|---|
Provider Name | David M Kraklau |
First Address | Saint Joseph, MI 49085-2529 |
Second Address | Saint Joseph, MI 49085-2529 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2013 |
Last Update Date | 05/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1033546122 | (05) | MI |