Provider Demographics
NPI:1811995699
Name:KRAFT, PHILLIP L (MD)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:L
Last Name:KRAFT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1701 SOUTH BLVD E
Mailing Address - Street 2:SUITE 390
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-6117
Mailing Address - Country:US
Mailing Address - Phone:248-293-0055
Mailing Address - Fax:248-293-3348
Practice Address - Street 1:1701 SOUTH BLVD E
Practice Address - Street 2:#390
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-6117
Practice Address - Country:US
Practice Address - Phone:248-293-0055
Practice Address - Fax:248-293-3348
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301044050207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4821281 10Medicaid
MI0F37182Medicare PIN
MI4821281 10Medicaid