Provider Demographics
NPI:1295843068
Name:KRAFT, MARY ALYCE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ALYCE
Last Name:KRAFT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:13535 DETROIT AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107
Mailing Address - Country:US
Mailing Address - Phone:216-221-7070
Mailing Address - Fax:216-221-7070
Practice Address - Street 1:13535 DETROIT AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107
Practice Address - Country:US
Practice Address - Phone:216-221-7070
Practice Address - Fax:216-221-7070
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35016165207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KR0087131Medicare ID - Type Unspecified
C00026Medicare UPIN