Provider Demographics
NPI:1073582417
Name:KRAKAUER, JESSE C (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:C
Last Name:KRAKAUER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1695 12 MILE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-2100
Mailing Address - Country:US
Mailing Address - Phone:248-548-9090
Mailing Address - Fax:248-548-8460
Practice Address - Street 1:1695 12 MILE RD STE 200
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-2100
Practice Address - Country:US
Practice Address - Phone:248-548-9090
Practice Address - Fax:248-548-8060
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301043287207Q00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF26666Medicare UPIN