Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | 4301067878 | MI |
NPI | 1437133097 |
---|---|
Provider Name | Dr. Kent Jerome Krach |
First Address | Clinton Township, MI 48038 |
Second Address | Clinton Township, MI 48038 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2005 |
Last Update Date | 28/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H57389 | (02) | |
H57389 | HAP (01) | MI |
KK067878 | BCBCM OTHER (01) | MI |