Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 4301043287 | MI |
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 4301043287 | MI |
NPI | 1073582417 |
---|---|
Provider Name | Dr. Jesse C. Krakauer |
First Address | Berkley, MI 48072-2100 |
Second Address | Berkley, MI 48072-2100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2006 |
Last Update Date | 10/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F26666 | (02) | NY |