Provider Demographics
NPI:1659476695
Name:KRAFFT, RUDOLPH MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:RUDOLPH
Middle Name:MICHAEL
Last Name:KRAFFT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1053 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44504-1007
Mailing Address - Country:US
Mailing Address - Phone:330-480-3605
Mailing Address - Fax:330-480-2948
Practice Address - Street 1:1053 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1007
Practice Address - Country:US
Practice Address - Phone:330-480-3605
Practice Address - Fax:330-480-2948
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35050407207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH151560OtherMEDICARE PTAN
OH0630302Medicaid
OH0630302Medicaid