Provider Demographics
NPI:1922462944
Name:KRAFT, MIKAIL (DO)
Entity Type:Individual
Prefix:
First Name:MIKAIL
Middle Name:
Last Name:KRAFT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 NE 96TH ST
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-1316
Mailing Address - Country:US
Mailing Address - Phone:816-412-2900
Mailing Address - Fax:
Practice Address - Street 1:1540 NE 96TH ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-1316
Practice Address - Country:US
Practice Address - Phone:816-412-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-06
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019024458208000000X
KS94-09092208000000X
MO390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics