Provider Demographics
NPI:1881687549
Name:KRESCH, PHILIP H (DPM)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:H
Last Name:KRESCH
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 1:26031 W WARREN ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-4716
Mailing Address - Country:US
Mailing Address - Phone:313-563-0660
Mailing Address - Fax:313-563-0002
Practice Address - Street 1:26031 W WARREN ST
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-4716
Practice Address - Country:US
Practice Address - Phone:313-563-0660
Practice Address - Fax:313-563-0002
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIPK001046213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI480001899OtherRR MEDICARE
MI140585413Medicaid
MI0Q27629003Medicare PIN
MI140585413Medicaid