Provider Demographics
NPI:1861499782
Name:KRAFT, MICHELE (DPM)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:KRAFT
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:547 FREDERICK ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-2635
Mailing Address - Country:US
Mailing Address - Phone:831-425-8637
Mailing Address - Fax:831-425-8634
Practice Address - Street 1:26615 CARMEL CENTER PL STE 103
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:CA
Practice Address - Zip Code:93923-8654
Practice Address - Country:US
Practice Address - Phone:831-425-8637
Practice Address - Fax:831-425-8634
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3521213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABB074OtherMEDICARE PTAN- GROUP
CA1124120654OtherNPI- GROUP
CAAU219ZMedicare PIN
CA1124120654OtherNPI- GROUP