Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | 4301041322 | MI |
NPI | 1114926805 |
---|---|
Provider Name | Michael Kraut |
First Address | Southfield, MI 48075-3707 |
Second Address | Southfield, MI 48075-3707 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2005 |
Last Update Date | 25/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
445322910 | (05) | MI |