Provider Demographics
NPI:1720006505
Name:KRAFT, JESS (DPM)
Entity Type:Individual
Prefix:
First Name:JESS
Middle Name:
Last Name:KRAFT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35948 W 13 MILE RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-2510
Mailing Address - Country:US
Mailing Address - Phone:248-592-1949
Mailing Address - Fax:248-592-2271
Practice Address - Street 1:35948 W 13 MILE RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-2510
Practice Address - Country:US
Practice Address - Phone:248-592-1949
Practice Address - Fax:248-592-2271
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI00661213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
485635436OtherBLUE CROSS BLUE SHIELD
U32873Medicare UPIN
5635436Medicare ID - Type Unspecified